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Medical/Surgical

Medical/Surgical

Medical/Surgical

WORK SETTING EXPERIENCE

Question 

Proficiency 

Frequency

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

GENERAL SKILLS EXPERIENCE

Advanced directives
Awareness of HCAHPS
Patient/family teaching
Computerized Documentation
Restraints
Lift/Transfer Devices
Specialty Beds
End of Life/Palliative Care
Automated Medication Dispensing Systems (Pyxis, Omnicell)
Bar Coding for medication administration
National Patient Safety Goals
Accurate Patient Identification
Interpretation and communication of lab values
Medication Administration 5 rights
Labeling (specimens, labs)
Medication Reconciliation
Pain Assessment and management
Infection Control
Universal Precautions
Isolation
Minimize risk for falls

CARDIAC MONITORING & EMERGENCY CARE

Rapid Response Teams
Cardiac Arrest/ CPR
Oxygen therapy and delivery
Pulse oximetry
Use of Doppler/pulse checks
Automatic/manual Blood Pressure checks

IV THERAPY

Starting and maintaining peripheral Iv’s
Blood Draw: venous
Multi Lumen Central line care and dressing changes
Blood Draw Central line
IV Push
Care & Management of Port a catheter
Care & Management of PICC/ Groshong/Hickman
TPN and Lipids
Administration of blood/blood products
Administration of Chemotherapy
Monitoring Chemotherapy (does not initiate)
IV drip calculations
IV fluids
Management of IV Infusion Pumps (Alaris, Baxter)
Management of elastomeric infusion
Management of intrathecal pumps

CARDIAC EXPERIENCE & CARE OF A PATIENT WITH

Auscultation of Irregular of Heart Sounds
Angina
Anticoagulation therapy
arrhythmias
Abdominal Aortic Aneurysm
Carotid Endarterectomy
Congestive heart Failure
Cardiomyopathy
Coagulation
Endocarditis
Femoral Popliteal Bypass
Hypertension
Pulse oximetry
Pericarditis
Peripheral Edema
Pulse/Circulation checks

MEDICATION ADMINISTRATION

Antihypertensive medications (Beta Blockers, Antiarrhythmics, Ace Inhibitors, Calcium Channel Blockers)
Inotropic: (digoxin)
Antiarrhythmics (Pacerone, Rythmol)
Beta Blockers (Sotalol, metroprolol)
Ace Inhibitors (Catopril, Ramipril, Vasotec)
Antianginals (isordil/nitrates)
Antilipemic: statins
Anticoagulation medications (heparin, Coumadin,
Diuretics

PULMONARY EXPERIENCE & CARE OF A PATIENT WITH

Assessment of abnormal breath sounds
Aspiration
Asthma
Emphysema
Airway management/suctioning (Oral, trach)
ABG’s recognition and treatment of abnormal values
Acute Pneumonia
Pneumothorax
Chest Tube care and management
Incentive spirometer
Pre/Post Thoracic Surgery
Lobectomy
Thoracentesis
Lung transplant
Oxygen administration
Ambu bag
Nasal Canula
Nebulizer treatments
Non-rebreather
Trach collar
Venti mask
TB
Tracheostomy Care
Bronchoscopy
Venti mask

MEDICATION ADMINISTRATION

Antihistamines
Bronchodilators
Expectorants and anti-tussins
inhalers
Steroids

NEUROLOGY EXPERIENCE & CARE OF A PATIENT WITH

Level of Consciousness
Comprehensive neuro assessment
Glasgow Coma Scale
CVA/ TIA
Intercranial Hemorrhage & hematoma
Reflex motor deficits
Visual communication deficit
CNS infection
Meningitis
Encephalitis
Alzheimer’s Disease
Delirium Tremens
Overdose
Neuromuscular disease
Multiple Sclerosis
Metastatic Tumor
Tumor resection
Pre/Post Neuro Surgery
Laminectomy
Assist Lumbar Puncture
Halo Traction
Seizure Disorder
Spinal Cord Injury
Traumatic Brain Injury

MEDICATION ADMINISTRATION USE & ADMINISTRATION OF THE FOLLOWING

Anticonvulsants (Dilantin/ Phenobarbital)
Antidepressants
Antiparkinson’s (Cogentin/Levodopa/Sinemet)
Corticosteroids

GASTROINTESTINAL EXPERIENCE & CARE OF A PATIENT WITH

Assessment of Bowel Sounds
Nutritional Status
Interpretation of labs and electrolyte imbalance
Bowel Obstruction
EGD
Insertion and management of NG tube
Bowel Prep/Colonoscopy
ERPC
Nausea/vomiting
Constipation/impaction
diarrhea
Insertion and management of small-bore feeding tubes (Dubhoff, Keofeed)
Management and care of PEG tub/feed
Management and care of gastrostomy tube/feed
Management and care of jejunostomy tube/feed
Gravity/bolus feedings
Kangaroo pump
Management and care of ostomy
Abdominal wounds
Pre/Post abdominal surgery
Paralytic Ileus
Management of post-surgical drains
Gastric Bypass
Peritonitis
GI bleed (upper/lower)
Hepatitis
Inflammatory Bowel Disease
Liver Failure
Liver Cancer
Paracentesis
Pancreatic Cancer

MEDICATION ADMINISTRATION USE & ADMINISTRATION OF THE FOLLOWING

Antiemetics
Antispasmodics
Anticholinergics
Laxatives

GENITOURINARY/RENAL EXPERIENCE & CARE OF A PATIENT WITH

Insertion and maintenance of urethral catheter
Care of Nephrostomy tube
Care of Suprapubic catheter
Fluid and Electrolyte disturbance
GU irrigation
Kidney Failure (acute/Chronic)
Measurement of Intake and Output Monitoring
Urine Retention

CARE OF PATIENT WITH

Pyelonephritis/UTI
BPH
TURP
Prostate Cancer
Nephrectomy
Ileoconduit
Renal Surgery
Hemodialysis
Peritoneal Dialysis
Shunts/Fistulas
Obstructions
Renal Trauma
Testicular Torsion

ORTHOPEDIC EXPERIENCE & CARE OF A PATIENT WITH

Assess Range of Motion
Assessment of color, warmth, movement, sensation
Amputation
Cast Care
Fractures
Splints
Traction
Trauma
Strains/Sprain
immobilization

METABOLIC/ENDOCRINE EXPERIENCE & CARE OF A PATIENT WITH

Diabetes
Blood Glucose Monitoring
Cushing’s Syndrome
Thyroid Disease
Post Thyroidectomy Care

SKIN/INTEGUMENTARY & CARE OF A PATIENT WITH

Skin assessment
Skin Breakdown monitoring
Staged Pressure Ulcers
Stasis Ulcers
Sterile dressing changes
Wound Vac maintenance and dressing changes

AGE-SPECIFIC EXPERIENCE

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)

Rank each of the following sections on a scale

No experience

Little Experience

High Experience

Master

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