Skills Checklist

Dialysis Checklist

Requested By:

Today's date

First Name:

Last Name:

Mobile Number:

Email Address:

Confirm Email:

WORK SETTING EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Inpatient Acute Care Facility
Trauma Center
Academic/Teaching Facility
Outpatient Care Facility
Long term care/Skilled Nursing
Clinic/Ambulatory
Home Health Setting

RENAL/GENITOURINARY EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Assessment Of Renal/Gu System
Insertion Of Foley

CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

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
Fluid Overload
Hypo / Hypertension
Disequilibrium Syndrome
Hypo / Hyperkalemia
Seizures
Clotted Access / Poor Blood Flow
Pyrogenic Reaction
Hemolysis
Air Embolus
Chest Pain
Anemia
Neuropathy
Pericarditis
Filter Blood Leak
Cardiac Arrest

HEMODIALYSIS / PROCEDURES:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Acute / Inpatient Dialysis
Chronic / Outpatient Dialysis
Dialysis Home Care
Pediatric Dialysis
Predialysis Nursing Assessment
Teaching The Dialysis Patient And Family

SET-UP / STARTING DIALYSIS TREATMENT:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Collect Blood Specimens
Anticoagulation
Dialysis
Fistula Gortex / Bovine Graft
Prep Vascular Access
Checking Alarm Settings / Machine
Priming Dialyzer
Conductivity Testing
Bicarbonate Dialysis

ASSESS PATIENT & EQUIPMENT DURING DIALYSIS:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Systems Assessment Of Patient
Volume Status
Vascular Access Function
Arterial And Venous Pressures
Blood Flow Rate
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

DISCONTINUED DIALYSIS:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Dialysis Catheter
Fistula / Vein Graft
Return Of Blood
Post Treatment Access Care
Equipment Clean Up
Sterilization Procedures

MISCELLANEOUS:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Care Of Immuno- suppressed Patient
Care Of Patient With Aids
Isolation Techniques
Assessment Of Wound Healing
Sterile Dressing Changes
Phlebotomy / Venous Blood Draw
Patient Education regarding Organ & Tissue Donation

AGE-SPECIFIC EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Newborn / neonate (birth-30 days)
Infant (31 days-1 year)
Toddler (ages 2-3 years)
Preschool (ages 4-5 years)
School age (ages 6-12 years)
Adolescent (ages 13-21 years)
Young adult (ages 22-39 years)
Adult (ages 40-64 years)
Older adult (ages 65-79 years)
Elderly (ages 80+ years)

TRAUMA EXPERIENCE:

Rank each of the following sections on a scale of 1 to 3: 1) Limited or no experience 2) Experienced, but may need review or supervision 3) Able to function independently *

Trauma score
Critical transports
Air transport (helicopter or jet)
Other transport experience
Level 1 trauma
Level 2 trauma
Level 1 infuser
Open chest massage
Peritoneal lavage
Hypovolemic shock
H+H / stat lab test machine
Post drowning
Auto transfuser / warmer