Med Surg Skills Checklist

First name:	Last name:
Phone:	Email:
SSN (last 4 only):	Date: (MM/DD/YYYY)

Key - for each box mark:

Limited or no experience
Somewhat experienced but may need review
Can function independently
Competent to supervise

	1	2	3	4
Cardiovascular
Assessment
Heart Sounds
Pulses
Neck Vein Distention
Peripheral Edema
Lab Values
Cardiac Enzymes
Electrolytes
Digoxin Levels
Procedures
Arrest Procedure/CPR Monitoring
Basic arrhythmia Interpretation
Equipment
Pacemakers
Doppler
Antiemboletic Hose
Care of Patient with
Acute MI
Aneurysm
Angina
Cardiac Arrest
Congestive Heart Failure
Cardiac Catheterization
Angioplasty
Post-Cardiac Surgery
Medications
Heparin Drip
Oral Anticoagulants
Oral and IV Antihypertensives
Oral and Topical Nitrates
Lasix
Digoxin
Care of Patient with
AIDS
ARDS
Asthma
Bronchoscopy
COPD
Fresh Tracheostomy
Lobectomy
Pneumonectomy
Pneumonia
Pulmonary Embolism
Thoracotomy
Tuberculosis
Medications
Albuterol
Theophylline
Aminophylline
Neurological
Assessment
Level of Consciousness
Neuro Check
Mental Status
Motor Movement
Seizure Activity
Procedures
Assist with Lumbar Puncture
Seizure Precautions
Equipment
Hyper/Hypothermia Blanket
Halo Traction
Application of Restraints
Support Devices
Cane
Cervical Collar
Sling
Walker
Wheelchair
Care of Patient with
Amputation
Arthoscopic Surgery
Cast
Osteoporosis
Pinned Fractures
Rheumatic/Arthritic Disease
Joint Replacement
Laminectomy/Cervical Fusion
Burns
Skin Grafts
Medications
Analgesics
Muscle Relaxants
Topical Agents
Gastriointestinal
Assessment
Bowel Sounds
Nutritional Status/Weight
Procedures
Tube Feeding/Gavage
Lavage
Guaiac Test
NG Tube Insertion
Ostomy Care
Paracentesis
Removal of Fecal Impaction
Enemas
Equipment
Feeding Pumps
Drains
Tubes
N/G
T-Tube
Miller Abbott
Blakemore
G-Tube
Endocrine/Metabolic
Assessment
Diabetic Coma
Insulin Reaction
Mental Status
Lab Values
Thyroid Function
Glucose Tolerance
Fasting Blood Sugar
Ketone Bodies
Serum Calcium
Procedures
Glucose Monitoring
Diabetic Teaching
Equipment
Insulin Pumps
Blood Glucose Sticks
Care of Patient with
Diabetes Mellitus
Disorders of Adrenal Gland
Disorders of Pituitary Gland
Hyperthyroidism
Hypothyroidism
Thyroidectomy
Medications
Steroids/Adrenocorticosteroids
Glucogon
Insulin
Regular
NPH
Lente
Humulin U
Thyroid Replacement
Oral Antihyperglycemics
Gynecologic Assessment
External Genitalia
Menstrual Cycle
Obstetric History
STDs/Infections
Pulmonary
Assessment
Breath/Lung Sounds
Breathing Patterns
Cough/Secretions
Skin/Nail Color

	1	2	3	4
Lab Results
Blood Gases
Procedures
Airway Management
Endotracheal Tube/Suctioning
Nasal Airway Suctioning
Oropharyngeal Suctioning
Tracheostomy Suctioning
Assist with Intubation
Assist with Thoracentesis
Assist with Chest Tube
Insertion/Removal
Chest Physiotherapy
Equipment
Oxygen Therapy & Medication Delivery Systems
Bag and Mask
External CPAP
Face Masks
Inhalers
Nasal Cannula
Portable Oxygen Tank
Trach Collar
Oximeter
Ventilators
Incentive Spirometer
Care of Patient with
Aphasia
Closed Head Injury
Coma
CVA
Cancer of Brain
Craniotomy
DTs
Meningitis
Neuromuscular Disease
Seizure Disorder
Spinal Cord Injury
Medications
Anticonvulsants
Antidepressants
Mannitol
Decadron
Solu-Medrol
Musculoskeletal/Integumentary
Assessment
Circulation Checks
Gait/Mobility
ROM/Joint Movement
Strength
Posture
Skin Integrity
Procedures
Crutch Walking
Pin Care
Cast Care
Use of Assistive Devices
Body Mechanics
Burn Care
Equipment
Continuous Motion Devices
Special Beds
Traction
Prosethics
K-Pad
Splints/Immobilizers
TENS
Hoyer Lift
Care of Patient with
Bowel Obstruction
Colostomy/Ileostomy
GI Bleeding
GI Surgery
Hepatitis
Inflammatory Bowel Disease
Liver Failure
Fistulas
Pancreatitis
Medications/Supplements
Antiemetics
Antispasmotics
Vitamins
Tube Feeding Solutions
Renal/Genitourinary
Assessment
Fluid and Electrolyte Balance
A/V Fistula/Shunt
Lab Values
Electrolytes
BUN and Creatinine
Procedures
Nephrostomy Tube Care
Peritoneal Dialysis
Bladder Training
Equipment
Bladder Irrigation
Specimen Collection/Urine Test
Care of Patient with
Hemodialysis
Peritoneal Dialysis
Renal Surgery
Renal Failure
Renal Transplant
TURP
Urinary Tract Infection
Cystoscopy
Medications
KCl
Diuretics
Procedures
Douche
Breast Self-Exam
Care of Patient with
Hysterectomy/Oopharectomy
Breast Biopsy
Lumpectomy
Mastectomy
Ectopic Pregnancy
PID
Endometriosis
Uterine Bleeding
Medications
Antifungal/Protozoan Agents
Hormone Replacement
Hematology/Oncology
Assessment
Skin Lesions/Tumors
Family History
Cardinal Signs of Cancer
Tumor Classifications
Lab Values
Blood Counts
Blood Chemistry
Procedures
Patient/Family Counseling
Grieving Process
Altered Image
Patient Teaching
Relaxation Techniques
Imagery
Side Effects of Chemotherapy
Bone Marrow Aspiration
Care of Patient with
Bone Marrow Transplant
Anemia
Immunosuppressed Conditions
Radiation Therapy/Implants
Inpatient Chemotherapy
Inpatient Hospice
Leukemias

Age Specific Experiences and Certifications

Age Specific Experiences	Infants and Toddlers (birth-2 years)	Children (3-12 years)	Adolescent (13-18 years)	Young Adult (19-39 years)	Middle Adults (40-64 years)	Older Adult (65+ years)
1. Knows the normal growth and development for each age group and adapts care accordingly.
2. Knows the different communication needs for each age group and changes communication methods and terminology accordingly.
3. Knows the different safety risks for each age group and alters the environment accordingly.
4. Knows the different medications, dosages, and possible side effects for each age group and administers medications accordingly.

The information I have provided in this skills checklist is true and accurate to the best of my knowledge. I hereby authorize Fortus Group to release this information to client facilities in relation to consideration of my employment.