|
Dialysis RN Clinical Skills Checklist | ||||||
| NAME | |||||||
| LAST 4 OF SSN | |||||||
| DATE | |||||||
| I hereby certify that ALL information I have provided on this skills checklist and all other documentation, is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination. | |||||||
| Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below. | |||||||
| Proficiency Scale: |
1 = No Experience 2 = Need Training 3 = Able to perform with supervision 4 = Able to perform independently |
||||||
| Rating Stars (Click) | RENAL/GENITOURINARY: | 1 | 2 | 3 | 4 | ||
 |
Assessment of Renal/GU System | ||||||
|
|
Insertion of Foley | ||||||
| Care of Patient with: | |||||||
|
|
Nephrostomy Tube | ||||||
|
|
AV Fistula / AV Graft | ||||||
|
|
Tunneled/Non-Tunneled Catheter | ||||||
|
|
Ileal Conduit | ||||||
|
|
Supra-Pubic Catheter | ||||||
|
|
Chronic Renal Failure | ||||||
|
|
Acute Renal Failure | ||||||
|
|
Nephrectomy | ||||||
|
|
Turp | ||||||
|
|
Peritoneal Dialysis | ||||||
|
|
Hemodialysis | ||||||
| Rating Stars (Click) | HEMODIALYSIS / PROCEDURES | 1 | 2 | 3 | 4 | ||
|
|
Acute/Inpatient Dialysis | ||||||
|
|
Chronic/Outpatient Dialysis | ||||||
|
|
Dialysis Home Care | ||||||
|
|
Pediatric Dialysis | ||||||
|
|
Predialysis Nursing Assessment | ||||||
|
|
Teaching the Dialysis Patient and Family | ||||||
| Rating Stars (Click) | SET-UP / STARTING DIALYSIS TREATMENT | 1 | 2 | 3 | 4 | ||
|
|
Collect Blood Specimens | ||||||
|
|
Anticoagulation | ||||||
|
|
Dialysis | ||||||
|
|
Fistula Gortex / Bovine Graft | ||||||
|
|
Prep Vascular Access | ||||||
|
|
Checking Alarm Settings/Machine | ||||||
|
|
Priming Dialyzer | ||||||
|
|
Conductivity Testing | ||||||
|
|
Bicarbonate Dialysis | ||||||
| Rating Stars (Click) | ASSESS PATIENT AND EQUIPMENT DURING DIALYSIS: | 1 | 2 | 3 | 4 | ||
|
|
Systems Assessment of Patient | ||||||
|
|
Volume Status | ||||||
|
|
Vascular Access Function | ||||||
|
|
Arterial and Venous Pressures | ||||||
|
|
Blood Flow Rate | ||||||
|
|
Subjective Response to Treatment | ||||||
|
|
Management of Anticoagulation | ||||||
|
|
Conductivity | ||||||
|
|
Ultrafiltration Calculation | ||||||
|
|
Operation of Myron L Meter | ||||||
|
|
Administration of Blood/Blood Products | ||||||
|
|
Administration of Mannitol | ||||||
|
|
Sequential Ultrafiltration / PUF | ||||||
|
|
Documentation of Treatment | ||||||
| Rating Stars (Click) | CARE OF PATIENT WITH: | 1 | 2 | 3 | 4 | ||
|
|
Fluid Overload | ||||||
|
|
Hypertension | ||||||
|
|
Hypotension | ||||||
|
|
Disequilibrium Syndrome | ||||||
|
|
Hyperkalemia | ||||||
|
|
Seizures | ||||||
|
|
Muscle Cramps | ||||||
|
|
Clotted Access/Poor Blood Flow Rate From Catheter | ||||||
|
|
Pyrogenic Reaction | ||||||
|
|
Hemolysis | ||||||
|
|
Air Embolus | ||||||
|
|
Chest Pain | ||||||
|
|
Anemia | ||||||
|
|
Neuropathy | ||||||
|
|
Pericarditis | ||||||
|
|
Filter Blood Leak | ||||||
|
|
Cardiopulmonary Arrest | ||||||
| Rating Stars (Click) | DISCONTINUE DIALYSIS: | 1 | 2 | 3 | 4 | ||
|
|
Dialysis Catheter | ||||||
|
|
Fistula / Vein Graft | ||||||
|
|
Return of Blood | ||||||
|
|
Post Treatment Access Care | ||||||
|
|
Equipment Clean Up | ||||||
|
|
Sterilization Procedures | ||||||
| Rating Stars (Click) | MISCELLANEOUS: | 1 | 2 | 3 | 4 | ||
|
|
Care of Immunosupressed Patient | ||||||
|
|
Care of Patient with AIDS | ||||||
|
|
Isolation Techniques | ||||||
|
|
Assessment of Wound Healing | ||||||
|
|
Sterile Dressing Changes | ||||||
|
|
Phlebotomy / Venous Blood Draw | ||||||
|
|
Discussing Organ & Tissue Donation | ||||||
| Rating Stars (Click) | Age Specific Competencies | 1 | 2 | 3 | 4 | ||
|
|
Infant (Birth - 1 year) | ||||||
|
|
Preschooler (ages 2-5 years) | ||||||
|
|
Childhood (ages 6-12 years) | ||||||
|
|
Adolescents (ages 13-21 years) | ||||||
|
|
Young Adults (ages 22-39 years) | ||||||
|
|
Adults (ages 40-64 years) | ||||||
|
|
Older Adults (ages 65-79 years) | ||||||
|
|
Elderly (ages 80+ years) | ||||||