8/7/2019 47_pacu_checklist

1/2

.

.

Post Anesthesia Care Unit (PACU) Skills Self Evaluation

1 2 3 4

Assess Respiratory StatusAssess Lung SoundsAirway Maintenance - Jaw ThrustAirway Maintenance - Chin LiftInsertion of Oral AirwayInsertion of Nasal AirwayRemoval of Nasal & Oral Airway

Administration of Oxygen:

Nasal CannulaFace Masks(With/Without Mist)Non-Rebreather Mask Trach Collar Face Tent

Incentive SpirometrySuctioning - NasotrachealSuctioning - ETT or TrachSuctioning - OropharyngealVentilate with Ambu-bag

Assist with Intubation (ETT)

ETT - Measure Cuff PressuresETT - Determine Air LeaksPulse OximetryDraw ABGs - Arterial PunctureDraw ABGs - Arterial LineInterpret ABGsPressure VentilatorsVolume VentilatorsEnd Tidal CO2 Monitor Troubleshoot Ventilator AlarmsCharting Respirations w/ Ventilator

Weaning from Ventilator ETT ExtubationChest PercussionChest TubesIdentify & Troubleshoot Airway Problems:

Displaced ETTUpper Airway Obstruction

1 2 3

Hemothorax

Care of Post-Op Thoracic SurgeryCare of Post-Op ENT Surgery

Administer PO MedicationsAdminister NG/GT MedicationsAdminister IM & SQ MedsPeripheral IV InsertionMix IV Infusion w/ AdditivesAdminister IV MedicationsUse of Heparin/Saline Locks

Needle-less Systems

Infusion PumpsDiscontinue Peripheral IV'sKnow Anesthetic Agents, Complications and Treatment

InhalantsInjectables

NarcoticsReversal AgentsMuscle Relaxants

Local AnesthesiaRegional AnesthesiaEpidural Anesthesia

Spinal AnesthesiaIntrathecal AnesthesiaAntiEmetic DrugsCardiacAuto BP Monitor (NIBP)Use of Cardiac MonitorsInterpretation of ArrhythmiasAssist with CodeDefibrillation/Cardioversion

Permanent Pacemaker

BronchospasmAspirationPneumothorax

Care of Patient with:

Temporary Pacemaker Cardiogenic Shock HypothermiaHyperthermiaMalignant Hyperthermic Crisis

Care of Post-Op Cardiac Surgery

1 2 3 4

1 2 3

Respiratory

1 2 3 4

1 2 3

1 2 3

Meds/IV Therapy

Use of Warming BlanketsVascularDraw Venous Blood (Peripheral)

Draw Blood from Central Line

Interpretation of Lab ResultsIntake and Output

1 2 3

This profile is for assessing your experience in specific clinical areas. This profile will not be a determining factor in acceptingyour application to become an employee of Supplemental Health Care (SHC).

Level of Proficiency: 1 No Experience 2 Need Training 3 Have performed this task, able to perform with supervision 4 Experienced, able to perform independently

8/7/2019 47_pacu_checklist

2/2

Peripheral PulsesUltrasonic Doppler Identify & Troubleshoot Vascular Problems:Edema/Fluid OverloadHypovolemiaAdmininster Blood/Blood Products:Packed RBCsWhole BloodPlasma/Albumin

Age-Appropriate Nursing Care: Ability to adapt care to incororate normal growth and development. Ability to adapt methodand terminology of client instructions as it relates to the age andcomprehension level of the client. Ability to ensure a safeenvironment - reflecting specific needs of the client and variousage groups.

Newborn/Infant (Birth - 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)

1 2 3

Other special skills / training (explain):

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize SHC to release this PACU Skills Self Evaluation to staffing clients of SHC.

Applicant Name & Title (Please Print)

SHC Representative Signature

Applicant Signature

Date

CryoprecipitateFluid Resuscitation (Crystalloids)Care of Patient with:

Central Venous Catheter (CVL)Arterial LineHickman/Broviac CathetersImplantable Venous PortPICC LineSwanGanz/Pul Art. Catheter Auto Infusion Pump

Assist CVL InsertionAssist Arterial Line InsertionArterial Line D/CNeurology

Neurological AssessmentGlascow Coma ScaleSeizure PrecautionsIntracranial Pressure MonitoringKnowledge of AnticonvulsantsCare of Post-Op CraniotomyCare of Post-Op Ophth. PatientPain ManagementPain Assessment & Pain ScaleAdmin of IV SedationAdmin of Narcotic AnalgesiaPCA PumpAssist w/ Epidural Cath InsertionAssess Epidural Anesthesia LevelAssess Spinal Anesthesia LevelAuto Med Dispense (Pyxis, SureMed)General NursingAdmit & Orient PatientsDischarge/Transfer PatientsSupervise Unlicensed PersonnelPre-operative Care/PreparationUrine dipstick

Blood Glucose Monitoring

Revise

1 2 3 4

1 2 3 4

1 2 3 4

Continuous Passive Motion (CPM)Skeletal TractionAmputationArthroscopy/ArthrotomyTotal Hip ReplacementTotal Knee ReplacementGastrointestinalAssess Bowel SoundsAssess GI Distress/Bleeding

Insertion/Monitoring NG TubeAbdominal WoundsWound DrainsEnterostomy CareCare of Post-Op Abd SurgeryCare of Liver TransplantGenitourinaryStraight/Foley Cath FemaleStraight/Foley Cath MaleGU IrrigationsSuprapubic Tube

Nephrostomy TubeCare of Patient with:Shunts & Fistulas

NephrectomyRenal TransplantMastectomyHysterectomyProstate Surgery

1 2 3

12 3 4

1 2 3 4

Positioning/Transferring

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3 4

1 2 3

1 2 3 4

RestraintsAdvance DirectivesPostmortem CareCare of Patient w/ Latex AllergyIsolation TechniquesCare of HIV PatientCare of Multiple Trauma PatientOrthopedicCast CareCirculation AssessmentCare of Patient with:

1 2 3 4

Orthopedic Care of Patient with Cont.Vascular Cont.