Long Term Acute Care Form

Long Term Acute Care Skills Checklist

LAST NAME: *

FIRST NAME: *

M.I.

1 = No Experience 2 = Very Little Experience 3 = Experience 4 = Very Experienced

Cardiovascular

Assessment:

Auscultation (rate, rhythm)

1

2

3

4

Blood Pressure, Non-Invasive

1

2

3

4

Doppler

1

2

3

4

Heart Sounds/Murmurs

1

2

3

4

Pulses/ Circulation Checks

1

2

3

4

Care of Patient with:

Abdominal Aortic Bypass

1

2

3

4

Aneurysm

1

2

3

4

Angina

1

2

3

4

Cardiac Arrest

1

2

3

4

Cardiomyopathy

1

2

3

4

Carotid Endarterectomy

1

2

3

4

Congestive Heart Failure (CHF)

1

2

3

4

Femoral-popliteal Bypass

1

2

3

4

Myocarditis

1

2

3

4

Post Acute MI (24-48 hours)

1

2

3

4

Post Angioplasty

1

2

3

4

Post Cardiac Cath

1

2

3

4

Post Cardiac Surgery

1

2

3

4

Thrombophlebitis

1

2

3

4

Medications:

Heparin Drip

1

2

3

4

Oral Anticoagulants

1

2

3

4

Oral & IVP Antihypertensives

1

2

3

4

Oral & Topical Nitrates

1

2

3

4

Thrombophlebitis

1

2

3

4

Telemetry:

Basic 12 Lead Interpretation

1

2

3

4

Basic Arrythmia Interpretation

1

2

3

4

Lead Placement

1

2

3

4

Pacemaker:

Permanent

1

2

3

4

Temporary

1

2

3

4

Endocrine/Metabolic

Assessment:

S/S Diabetic Coma

1

2

3

4

S/S Insulin Reaction

1

2

3

4

Care of Patient with:

Diabetes Mellitus

1

2

3

4

Disorders of Adrenal Gland

1

2

3

4

Disorders of Pituitary Gland

1

2

3

4

Hyperthyroidism

1

2

3

4

Hypothyroidism

1

2

3

4

Thyroidectomy

1

2

3

4

Administration/Teaching of Medications:

Insulin

1

2

3

4

Oral Hypoglycemics

1

2

3

4

Steroids

1

2

3

4

Thyroid

1

2

3

4

Blood Glucose Equipment & Procedures:

Electronic Measuring Device

1

2

3

4

Performing Finger Stick

1

2

3

4

Visual Blood Glucose Strips

1

2

3

4

Indwelling Insulin Pump

1

2

3

4

Gastrointestinal

Interpretation of Blood Chemistry

1

2

3

4

Assessment:

Abdominal/Bowel Sounds

1

2

3

4

Fluid Balance

1

2

3

4

Nutritional

1

2

3

4

Care of Patient with:

Bowel Obstruction

1

2

3

4

Colostomy/Ileostomy

1

2

3

4

Nutritional

1

2

3

4

GI Surgery

1

2

3

4

Hepatitis

1

2

3

4

Inflammatory Bowel Disease

1

2

3

4

Invasive Diagnostic Testing

1

2

3

4

Liver Failure

1

2

3

4

Paralytic Ileus

1

2

3

4

Equipment & Procedures:

Flexible Feeding Tube

1

2

3

4

Placement of Nasogastric Tube

1

2

3

4

Salem Sump to Suction

1

2

3

4

Administration of Tube Feeding:

Feeding Pump

1

2

3

4

Gravity Feeding

1

2

3

4

Saline Lavage

1

2

3

4

Management of :

Gastrostomy Tube

1

2

3

4

Jejunostomy Tube

1

2

3

4

T-Tube

1

2

3

4

Infectious Diseases

Interpretation of Lab Results:

Blood Count

1

2

3

4

Care of Patient with:

AIDS

1

2

3

4

Hepatitis

1

2

3

4

Lyme Disease

1

2

3

4

Equipment & Procedures:

Fever Management

1

2

3

4

Isolation

1

2

3

4

Neurological

Administration of Anticonvulsants

1

2

3

4

Assessment:

Glasgow Coma Scale

1

2

3

4

Level of Consciousness

1

2

3

4

Care of Patient with:

1

2

3

4

Aneurysm Precautions

1

2

3

4

Basal Skull Fracture

1

2

3

4

Closed Head Injury

1

2

3

4

Coma

1

2

3

4

CVA

1

2

3

4

DTs

1

2

3

4

Encephalitis

1

2

3

4

Externalized VP Shunts

1

2

3

4

Meningitis

1

2

3

4

Neuromuscular Disease

1

2

3

4

Post Craniotomy

1

2

3

4

Seizures

1

2

3

4

Spinal Cord Injury

1

2

3

4

Equipment & Procedures

Assist with Lumbar Puncture

1

2

3

4

Hyper/Hypothermia Blanket

1

2

3

4

Oncology

Assessment:

Nutritional Status

1

2

3

4

Pain Control

1

2

3

4

Interpretation of Lab Results:

Blood Chemistry

1

2

3

4

Blood Counts

1

2

3

4

Care of Patient with:

Bone Marrow Transplant

1

2

3

4

Fresh Oncologic Surgery

1

2

3

4

Inpatient Chemotherapy

1

2

3

4

Inpatient Hospice

1

2

3

4

Leukemia

1

2

3

4

Radiation Implant

1

2

3

4

Equipment & Procedures:

Reverse Isolation

1

2

3

4

Orthopedics

Assessment:

Circulation Checks

1

2

3

4

Gait

1

2

3

4

Range of Motion

1

2

3

4

Skin

1

2

3

4

Care of Patient with:

Amputation

1

2

3

4

Arthroscopic Surgery

1

2

3

4

Cast

1

2

3

4

Osteoporosis

1

2

3

4

Pinned Fractures

1

2

3

4

Rheumatic/Arthritic Disease

1

2

3

4

Total Hip Replacement

1

2

3

4

Total Knee Replacement

1

2

3

4

Equipment & Procedures

Continuous Passive Motion Devices

1

2

3

4

Traction

1

2

3

4

Support Devices:

Cane

1

2

3

4

Cervical Collar

1

2

3

4

Gait Belt

1

2

3

4

Prosthetic

1

2

3

4

Sling

1

2

3

4

Transfer Boards

1

2

3

4

Walker

1

2

3

4

Wheelchair

1

2

3

4

Pain Management

Assessment of Pain Level/Tolerance

1

2

3

4

Care of Patient with:

Epidural Anesthesia/Analgesia

1

2

3

4

IV Conscious Sedation

1

2

3

4

Narcotic Analgesia

1

2

3

4

Patient Controlled Analgesia

1

2

3

4

Phlebotomy/IV Therapy

Drawing Blood from Central Line

1

2

3

4

Drawing Venous Blood

1

2

3

4

Use of Blood/Blood Products

1

2

3

4

Equipment & Procedures:

Albumin

1

2

3

4

Cryoprecipitate

1

2

3

4

Packed Red Blood Cells

1

2

3

4

Plasma

1

2

3

4

Whole Blood

1

2

3

4

Starting IVs:

Angiocath

1

2

3

4

Butterfly

1

2

3

4

Heparin Lock

1

2

3

4

Care of Patient with:

Central Line-Broviac

1

2

3

4

Central Line-Groshong

1

2

3

4

Central Line-Hickman

1

2

3

4

Central Line-Portacath

1

2

3

4

Central Line-Quinton

1

2

3

4

Peripheral Line/Dressing

1

2

3

4

Pulmonary

Assessment:

Breath Sounds

1

2

3

4

Rate and Work of Breathing

1

2

3

4

Interpretation of Lab Results:

Blood Chemistry

1

2

3

4

Blood Gases

1

2

3

4

Care of Patient with:

Bronchoscopy

1

2

3

4

COPD

1

2

3

4

Fresh Tracheostomy

1

2

3

4

Lobectomy

1

2

3

4

Pneumonectomy

1

2

3

4

Pneumonia

1

2

3

4

Pulmonary Embolism

1

2

3

4

Thoracotomy

1

2

3

4

Tuberculosis

1

2

3

4

Equipment & Procedures:

Assist with Intubation

1

2

3

4

Assist with Thoracentesis

1

2

3

4

Care of Patient on a Ventilator

1

2

3

4

Chest Physiotherapy

1

2

3

4

Incentive Spirometry

1

2

3

4

Oximetry

1

2

3

4

Airway Management Devices/Suctioning:

Endotracheal Tube/Suctioning

1

2

3

4

Nasal Airway/Suctioning

1

2

3

4

Oropharyngeal/Suctioning

1

2

3

4

Sputum Specimen Collection

1

2

3

4

Tracheostomy/Suctioning

1

2

3

4

Care of Patient with Chest Tube

Assist with Set-up & Insertion

1

2

3

4

Measuring and Emptying

1

2

3

4

Removal

1

2

3

4

O2 Therapy & Medication Delivery

Bag and Mask

1

2

3

4

External CPAP

1

2

3

4

Face Masks

1

2

3

4

Inhalers

1

2

3

4

Nasal Cannula

1

2

3

4

Portable O2 Tank

1

2

3

4

Trach Collar

1

2

3

4

Renal/Genitourinary

Assessment:

Arterio Venous Fistula/Shunt

1

2

3

4

Fluid Balance

1

2

3

4

Interpretation of Lab Results:

BUN Creatinine

1

2

3

4

Electrolytes

1

2

3

4

Care of Patient with:

Hemodialysis

1

2

3

4

Nephrectomy

1

2

3

4

Peritoneal Dialysis

1

2

3

4

Renal Failure

1

2

3

4

Renal Transplant

1

2

3

4

TURP

1

2

3

4

Urinary Diversion

1

2

3

4

Ileal Conduit Nephrostomy

1

2

3

4

Urinary Tract Infection

1

2

3

4

Equipment & Procedures:

Insertion & Care of Catheter:

Female

1

2

3

4

Male

1

2

3

4

Catheter Care:

3-Way Foley

1

2

3

4

Supra-pubic

1

2

3

4

Bladder Irrigations:

Continuous

1

2

3

4

Intermittent

1

2

3

4

Specimen Collection:

Routine

1

2

3

4

24 Hour

1

2

3

4

Wound Management

Assessment:

Skin for Impending Breakdown

1

2

3

4

Stasis Ulcers

1

2

3

4

Surgical Wound Healing

1

2

3

4

Care of Patient with:

Burns

1

2

3

4

Pressure Sores

1

2

3

4

Staged Decubitus Ulcers

1

2

3

4

Surgical Wounds with Drain(s)

1

2

3

4

Traumatic Wounds

1

2

3

4

Equipment & Procedures:

Air Fluidized, Low Airloss Beds

1

2

3

4

Sterile Dressing Changes

1

2

3

4

Wound Care/Irrigations

1

2

3

4

Age Specific Practice Criteria

Age Groups

Newborn/Neonate (birth- 30 days)

1

2

3

4

Infant (30 days- 1 year)

1

2

3

4

Toddler (1-3)

1

2

3

4

Preschooler (3-5)

1

2

3

4

School Age Children (5-12)

1

2

3

4

Adolescents (12-18)

1

2

3

4

Young Adults (18-39)

1

2

3

4

Middle Age Adults (39-64)

1

2

3

4

Older adults (64 +)

1

2

3

4

Ability to:

Adapt Care to Incorporate Normal Growth & Development

1

2

3

4

Adapt Method & Terminology of Patient Instructions to their Age, Comprehension and Maturity Level

1

2

3

4

Ensure a Safe Environment Reflecting Specific Needs

1

2

3

4

Understand the Different Medications, Dosages and Possible Side Effects for Age Group

1

2

3

4

Administer Medications Properly

1

2

3

4

* I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize the Company to release this LTAC Checklist to the Client facilities in relation to consideration of employment as a Traveler with those facilities.

Signature: *

Date: