Skills Checklist – LPN Skills Checklist – LPN Name First Last Phone Email CLINICAL AREAS* Rarely Some Experience Proficient Trainer / Preceptor N/A Burn Unit Cardiac Care Emergency Department Intensive Care Unit Step Down Gynecology Labor and Delivery Medical Mother/Baby Neurology Nursery Obstetrics OR Oncology Orthopedics Pediatrics Post Partum Psychiatry Rehabilitation Renal/Dialysis Respiratory Surgical Telemetry Doctor’s Office Health Department Corrections Home Health Long Term Care Hospice Respite Care Outpatient Clinic Nursing Home CORE SKILLS* Rarely Some Experience Proficient Trainer / Preceptor N/A Admissions of a Patient Transfer of a Patient Discharge of a Patient Assist with Emergency Situations/Codes Vital Signs Post Mortem Care Assist with Defibrillation Assist with Cardioversion Documentation Patient and Family Education Assessment of Abuse Restraints Body Mechanics Aseptic Technique Isolation Precautions CARDIOVASCULAR – CARE OF PATIENT WITH:* Rarely Some Experience Proficient Trainer / Preceptor N/A Auscultation (rate, rhythm) Blood Pressure/Non-invasive Doppler Heart Sounds/Murmurs Angina Cardiac Arrest Cardiomyopathy Carotid Endarterectomy Congestive Heart Failure Femoral-Popliteal Bypass Myocarditis Status Post MI Post Angioplasty Post Cardiac Cath Thrombophlebitis Temporary Pacemaker Permanent Pacemaker Cardiac Enzymes Blood Chemistries Basic Arrhythmia Interpretation Lead Placement PULMONARY – CARE OF PATIENT WITH:* Rarely Some Experience Proficient Trainer / Preceptor N/A Ventilator/Weaning Breath Sounds Rate and Work of Breathing Arterial Blood Gases (ABG) Asthma COPD Tracheostomy Lobectomy Pneumonectomy Pneumonia Pulomonary Embolism Thoracotomy Tuberculosis Pulmonary Edema Pneumothorax Laryngospasm Endotracheal Tube/Suctioning Nasal Airway/Suctioning Oropharyngeal/Suctioning Sputum Specimen Collection Tracheostomy/Suctioning Assist with Intubation Assist with Thoracentesis Chest Tube Management Chest Physiotherapy Incentive Spirometry Pulse Oximetry Bag and Mask Face Mask Nasal Cannula Portable O2 Tank NEUROLOGICAL – CARE OF PATIENT WITH:* Rarely Some Experience Proficient Trainer / Preceptor N/A Glascow Coma Scale Level of Consciousness Assist with Lumbar Puncture Use of Hypo-Hyperthermia Blanket Aneurysm Precautions Basal Skull Fracture Closed Head Injuries Coma* CVA TIA Delerium Tremens* Encephalitis Meningitis Neuromuscular Disorders Psychiatric Disorders Seizures Overdose Guillain- Barre Syndrome Externalized VP Shunts Post Craniotomy Spinal Cord Injuries ORTHOPAEDICS – CARE OF PATIENT WITH:* Rarely Some Experience Proficient Trainer / Preceptor N/A Circulation checks Gait Range of Motion Skin Wheelchair Use Cane/Crutches/Walker Use Amputation Arthroscopic Surgery Cast Splint Knee Immobilizer Osteoporosis Pinned Fractures Total Joint Replacements Continuous Passive Motion Devices Cervical Collar Prosthetics Traction- Bucks/Skeletal Auto Transfuser GASTROINTESTINAL – CARE OF PATIENT WITH:* Rarely Some Experience Proficient Trainer / Preceptor N/A Abdominal/ bowel sounds Fluid Balance Placement of NG tube Placement of Flexible Feeding Tube Administration of Tube Feeding Feeding Pumps Gravity Feeding Salem Sump to Suction Care of Gastrostomy Tube Colostomy Care Bowel Obstruction GI Bleeding GI Surgery Hepatitis Inflammatory Bowel Disease Liver Failure Liver Transplant Paralytic Ileus Colostomy/Ileostomy Abdominal Trauma GASTROINTESTINAL – CARE OF PATIENT WITH: RENAL/GENITOURINARY – CARE OF PATIENT WITH:* Rarely Some Experience Proficient Trainer / Preceptor N/A Fluid Balance Urinary Output BUN &Creatinine Catheter Care Specimen Collection- Routine Specimen Collection- 24 Hours Specimen Collection- Clean Catch Insertion & Care of Straight and Foley Catheters- Female Insertion & Care of Straight and Foley Catheters- Male Hemodialysis Nephrectomy Peritoneal Dialysis Renal Failure Renal Transplant TURP Ileal Conduit Bladder Irrigations Urinary Tract Infections Gyn Surgery Renal trauma ENDOCRINE/ METABOLIC – CARE OF PATIENT WITH:* Rarely Some Experience Proficient Trainer / Preceptor N/A S/S Diabetic Coma S/S Insulin Coma Blood Glucose Monitoring Performing Finger/Heel Stick Sliding Scale Insulin Protocols Adrenal Disorders (Addison’s) Diabetes Mellitus Diabetes Insipidus (Pituitary Disorder) Diabetic Ketoacidosis Hyperthyroidism Hypothyroidism Thyroidectomy WOUND MANAGEMENT* Rarely Some Experience Proficient Trainer / Preceptor N/A Assess Skin for Impending Breakdown Surgical Wound Healing Sterile Dressing Change Wound Vac Wet to Dry Dressings First Degree Burns Second Degree Burns Third Degree Burns Decubitus Ulcers Surgical Wounds with Drains Traumatic Wounds Wound Care Irrigations Multiple Abdominal Wounds and Drains Gunshot Wound Stab Wound Lacerations Abrasions ONCOLOGY – CARE OF PATIENT WITH:* Rarely Some Experience Proficient Trainer / Preceptor N/A Bone Marrow Transplant Inpatient Chemotherapy Leukemia Radiation Implant Lymphoma Depressed Immune System Radiation Therapy Fresh Oncology Surgery INFECTIOUS DISEASE – CARE OF PATIENT WITH:* Rarely Some Experience Proficient Trainer / Preceptor N/A HIV MRSA C. Difficile VRE Hepatitis Influenza Isolation Precautions INTRAVENOUS THERAPY* Rarely Some Experience Proficient Trainer / Preceptor N/A Site Assessment Administration of Blood & Blood Products Drawing Blood from a Central Line IV Insertion Heplock Flushes Administration of IV Fluid Administration of IV Piggy Back Administration of IV Push Medications Access VAD Central Line Peripheral Line Administration TPN/Lipids PAIN MANAGEMENT* Rarely Some Experience Proficient Trainer / Preceptor N/A Assessment of Pain Level/Tolerance Administration of Narcotic Analgesia PCA Pumps IV Conscious Sedation Epidural Anesthesia MISCELLANEOUS* Rarely Some Experience Proficient Trainer / Preceptor N/A Computerized Charting Automated Med. Dispensing Systems Safe Needle Devices PO Medications IM Injections SQ Injections Z- Track Injections Rectal Suppositories Nasal Sprays Ear Drops Eye Drops Inhalers Assist with Emergency Drugs/Code Cart Types of Computerized Charting: (If applicable) Types of Automated Med. Dispensing Systems: (If applicable) Personal Age Group Experience* Rarely Some Experience Proficient Trainer / Preceptor N/A Newborn (birth – 30 days) Infant (30 days – 1 year) Toddler (1 – 3 years) Preschooler (3 – 5 years) School Age (5 – 12 years) Adolescents (12 – 18 years) Young Adults (18 – 39 years) Middle Adults (39-64 years) Older Adults (64+ years) Do you speak any languages other than English?* No If yes, enter languages above, separated by commas. Confirmation* I attest that the information I have given is both true and, to the best of my knowledge, represents an accurate self assessment of my professional skills and/or education. Signature Date Date Format: MM slash DD slash YYYY