Read HSI_Med_Surg_Checklist.pdf text version

Health Staffing International #230 ­ 618 Columbia Street New Westminster, BC V3M 1A5 Office: 604 520-7775 Fax: 604 519-1552

HSI SKILLS ASSESSMENT - Medical/Surgical

NAME: DATE:

Answer the following questions indicating with a check mark the skill level that best applies: SKILL LEVEL KEY: 0=No Experience; never done or dealt with, 1=Minimal; requires supervision, performed once, 2=Competent; can perform safely and independently, 3=Expert; able to teach skill

0 GENERAL

1) 2) 3) 4) 1) 2) 3) 4) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 1) 2) 3) 4) 5) 6) 7) 8) 9) Skin integrity/ protection of Range of motion Charting (Focus) Use of patient lifting devices Diabetes Colonstomy/ Ileostomy Nutrition Skin Care Directing CPR Team Cardio Pulmunary Arrests\ Management Care of Pacemaker Patient Pre/Post-op Angioplasty Care of 48+hr Post-op Open Heart Patient Post-op Vascular Patients (as in Aneurysms) Angina (Acute or Chronic) Ability to interpret Cardiac Rhythms Patients with Central Lines Assessing Abnormal Heart Sounds Assessing and Treating Orthostatic Hypotensionn Assessing Chest Sounds Administering Oxygen (Nasal, Mask, Canula) Assisting with Set-up and Maintentaning Chest Tubes Using Oxygen Saturation Monitor Using Chest Drainage Systems Caring for Patients with Pulmonary Emboli Caring for Patients with Tracheostomy Changing Tracheostomy Nasal Tracheal suctioning

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PATIENT AND FAMILY TEACHING

CARDIOVASCULAR

PULMONARY

HSI

Medical Sergical Skills Assessment

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0 PULMONARY (continued)

10) 11) 12) 13) 14) Pre/Post Thoracic Surgery Instructing Patient in use of Incent. Spirometer COPD CHF Asthma

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ENDOCINE

1) Caring for Diabetic Patient 2) Checking Capilliary Blood Glucose 3) Hormone Therapy

ONCOLOGY

1) Standard Precations 2) Caring for AIDS Patient 4) Mixing and Administering Chemo Agents

GASTROINTESTINAL

1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 1) 2) 3) 4) 5) 6) 7) 8) 9) Inserting and Maintaining NG Feeding Tubes Administering Feeding Tubes Checking Tube Feeding and NG Tube Placement Inserting and Maintaining Continuous Suction NG Tubes Caring for Acute GI Bleed Managing Abdominal Wounds Pre/Post-Op GI Surgery Stools Tests Assessing Bowels Sounds Ileostomy/Colostomy Care Obtaining Culture Samples for Bacterial, Viral Studies Nasal Washing for ILI Caring for Patient on Total Parenteral Nutrition Inserting/ Maintaining Urinary Catheters Caring for Patient with Acute Renal Failure Caring for Patient with Chronic Renal Failure Caring for Post Renal/ Genitourinary Surgery Caring for Patient with Post Peritoneal Dialysis Caring for Patient with Post Hemodialysis Collecting Urine Specimens Managing Urostomy Managing Suprapubic Catheter

GENITOURINARY/ RENAL

HSI

Medical Sergical Skills Assessment

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0 NUROLOGY

1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 1) 2) 3) 4) 5) 6) 7) 8) 9) Neuro Vital Assessment Seizure Precations Managing Halo Traction Caring for Patients with Spinal Cord Injury Pre/ Post Neurological Surgery Caring for Patients with: Degenerative Diseases of the Nervous System Drug Overdoses Head Injury Cerebral aneurysm Chronic CVA/ TIA Managing Patient with Epidurl Catheter Caring for Patients with: Braces Casts Collars Slings/Sprints Skeletal and Skin Traction Traction Using TENS Unit Crutch Walking/Walkers Total Knee Replacement Total Hip Replacement Athroscopy/ Athrotomy Amputation Caring for Patient on Continuous Passive Motion Administering Blood and Blood Products Caring for Drains and Tubes (i.e. Hemovac) Establishing IV's Obtaining Peripheral Venous Blood Monitoring and assessing I and O Performing Complex Dressing Changes Using PCA Systems Using SCD or Venidyne Devices Using PICC , Hickman Central Line

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MUSCULOSKELETAL

MISCELLANEOUS

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Medical Sergical Skills Assessment

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0 CARING FOR PATIENTS RECEIVING THE FOLLOWING

1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) Acetaminophen (Tylenol) Acetylsaliccylic Acid (Aspirin, ASA) Antibiotics Beta Blockers Calcium Channel Blockers Cimetidine (Tagamet) Codeine Dexamethasone (Decadron) Diazepam (Valium) Digoxin (Lanoxin) Duramorph Furosemide (Lasix) Heparin Insulin Lorazepam (Ativan) Morphine Naloxone (Narcan) Nitroglycerine Phenytoin (Dilantin) Potassium Chloride Theophylline Verapamil (Calan) Warfarin (Coumadin) Inhalation Medications Oral Medications Topical Medications Vaginal Suppositories Rectal Suppositories Intravenously Subcutaneously Intra Muscularly Naso/ Gastric Gastric J Tube

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ADMINISTERING MEDICATION

Please check the box or boxes that corresponds with your expertise in age related care: Newborn/ Neonate (birth to 30 days ) Infant (30 days to 1 year Toddler (1 to 3 years) Preschooler (3 to 5 years) School age children (5 to 12 years) Adolescent (12 to 18 years) Young Adult (18 to 39 years) Middle Adult (39 to 64 years) Old Adult (64 years and older)

I confirm 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.

Signature

Date

HSI

Medical Sergical Skills Assessment

4

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