__ POST ANESTHESIA/RECOVERY KNOWLEDGE

& SKILLS CHECKLIST_

NAME:       3. Obtaining CVP reading
ID #:       4. Recognition of abnormal
DATE:       measurement
5. Discontinuing a central line

This Skills Checklist is for use by nurses DIRECTIONS: Please indicate your level of
with more than one year experience in experience by placing a check (√) in the
their discipline and specialty. Please be box. Experience level:
accurate with your assessment. 1 NO EXPERIENCE
2 MINIMAL EXPERIENCE-requires
DESCRIPTION 1 2 3 4 supervision/assistance
GENERAL 3 MODERATELY EXPERIENCED-requires
1. Charge duties initial review, then performs
2. Primary care independently
3. Team nursing 4 VERY EXPERIENCED- proficient
4. Universal Precautions
5. Isolation
6. Physical DESCRIPTION 1 2 3 4
assessment/Admission of Blood Pressure Monitoring
patient 1. Manual and Doppler devices
7. Post-Surgical documentation 2. Arterial
8. Computer use documentation 3. Automatic
PRECAUTIONS 4. Swan-Ganz Pressure
1. Universal Precautions Monitoring
2. Regular Isolation 5. Intracranial Pressure
3. Reverse Isolation Monitoring
4. Respiratory Isolation 6. Interpretation of Blood Studies
5. Skin/Wound Isolation AIRWAY
6. Dressing Change Isolation Airway Management
MONITORING 1. Assessment of tidal volumes
Cardiac Monitoring 2. Assessment of breath sounds
1. Interpretation of Arrythmias 3. Insertion/removal nasal & oral
2. Recognition of basic cardiac airways
rhythms 4. Oral, nasal, nasotracheal, &
3. Troubleshoot monitors endotracheal suctioning
4. Peripheral pulses, skin color, Airway complications and their
temp management
Arterial Pressure Monitoring 1. Respiratory obstruction
1. ABG Interpretation 2. Hypoventilation
2. Calibration Care of arterial line 3. Laryngospasm/bronchospasm
3. Discontinuing an arterial line 4. Aspiration
4. Recognition of normal 5. Atelectasis
waveform IV THERAPY
5. Withdrawal of arterial blood 1. Heparin/Saline lock
Central Venous Pressure Monitoring 2. Insertion of IV line
1. Set up CVP line 3. CVP lines and dressing
2. Care of CVP line changes
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 __ POST ANESTHESIA/RECOVERY KNOWLEDGE
& SKILLS CHECKLIST_
4. Operation of Infusion pumps
5. Hanging blood/blood products
6. Care of Cut Down
7. Venipuncture
2. Insertion of IV line
3. CVP lines and dressing
changes
EQUIPMENT & SKILLS
1. Care/Management of intubated
patients
a. Assisting with intubation

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& SKILLS CHECKLIST_
NAME:       c. Ambu
ID #:       6. Ventilator management:
DATE:       a. Monitoring
DESCRIPTION
EQUIPMENT & SKILLS (CONT)
1. Care/Management of intubated patients
(Cont)
b. Blakemore (MN) for bleeding
c. Chest tubes
d. Endotracheal tubes
e. Extubation
f. GI tubes
g. Miller Abbott
h. Nasogastric tubes
i. Tracheostomy care
j. Use/selection of mask with
ambu
k. Ambulation
2. Crisis Management
a. Anesthetic and reversal
agents
b. Arrest Med Administration
c. Cardiac drug administration
d. CPR
e. Defibrillation
f. Hypotensive Crisis
Management
g. Hypertensive Crisis
Management
h. IV Additives and IVPB’s
i. Pain evaluation
j. Respiratory/cardiac
emergencies & arrests
k. Shock Management
l. Vasoactive Drug
Administration
3. Diagnosis of problems
a. Fresh MI
b. GI bleed
c. Renal failure
4. Management of patients with
tracheostomies
5. Oxygen therapy
a. O2 Equipment
a. Nasal cannula
b. T-tube
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POST ANESTHESIA/RECOVERY KNOWLEDGE
parameters/Adjust settings
1 2 3 4 DESCRIPTION 1 2 3 4
b. Operation/Troubleshooting
7. Arterial blood gas
interpretation
8. Drug interactions,
incompatibilities,
and side effects
9. Assessment of peripheral
pulses, skin
color & temperature
10. Patient stimulation and stir-up
regimen
11. Operation of PCA pumps
12. Management of the infectious
patient
13. Management of the pediatric
patient
14. Neurological checks
15. Operation of Gomco/Emerson
suction
16. Set up and run 12 lead EKG
17. Cast care and observation
19. GU
a. Foley catheter insertion
(male)
b. Foley catheter insertion
(female)
c. 3-way Foley
d. Suprapubic
d. Catheter care
19. Discharge of patient
MEDICATIONS & CARE OF PATIENT WITH:
1. Aminophyline
2. Bumex
3. Chemotherapy
4. Decadron
5. Demerol
6. Digoxin
7. Dilantin
8. Dopamine
9. Hyperalimentation
administration
10. Intralipid administration
 __ POST ANESTHESIA/RECOVERY KNOWLEDGE
& SKILLS CHECKLIST_
11. Isuprel
12. Lasix
13. Lidocaine
14. Morphine
15. Nipride
16. Pitressin
17. Valium
AGE SPECIFIC PACU/RECOVERY
1. Infant (Birth to 1 year)
2. Toddler (1-4)
3. Children (5-11)
4. Adolescent (12-18)

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 __ POST ANESTHESIA/RECOVERY KNOWLEDGE
& SKILLS CHECKLIST_
NAME:       4. Able to provide a safe environment
ID #:       according to the specific needs of various
DATE:       age groups.

DESCRIPTION 1 2 3 4 A B C D E F G H I
AGE SPECIFIC PACU/RECOVERY (CONT)
5. Adult (18-60)
6. Geriatric MY EXPERIENCE IS PRIMARILY IN:
COMPUTERIZED CHARTING NEUROLOGY       years
1. Cerner PULMONARY       years
2. Eclipsys SURGICAL       years
3. Epic MEDICAL       years
4. McKesson CARDIAC CARE       years
5. Meditech TELEMETRY       years
6. Other:
I HAVE CURRENT CERTIFICATIONS FOR:
TYPE EXPIRATION
Please check the boxes below for each
DATE (MM/DD/YY)
age group for which you have expertise in
providing age-appropriate nursing care. ARRHYTHMIA      
A. Newborn/Neonatal (birth – 30 days) CRITICAL CARE      
B. Infant (30 days – 1 year) ACLS      
C. Toddler (1 – 3 years) BLS      
D. Preschool (3 – 5 years) TNCC      
E. School Age Children (5 – 12 years) NRP      
F. Adolescent (12 – 18 years) PALS      
G. Young Adults (18 – 39 years) NALS      
H. Middle Adults (40 – 64 years) CCRN      
I. Older Adults (64 + years) Other            

EXPERIENCE WITH AGE GROUPS: The information I have provided in this

1. Able to assess age appropriate knowledge and skills checklist it true and
behavior, motor skills and physiological accurate to the best of my knowledge.
norms.            
A B C D E F G H I Signature Date
(Written/Electronic)
ID #:      
2. Able to adapt care according to normal
This skills checklist has been reviewed
growth and development.
and approved by Nicole Bloxham, RN.
A B C D E F G H I
           
Signature Date
(Written/Electronic)
3. Able to communicate and instruct ID #:      
patient according to their age, maturity
and comprehension ability. Please return to: Northwest Nurse Staffing
Company, PA
A B C D E F G H I ATTN: Records Dept.
Fax: (866) 352-4338

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 __ POST ANESTHESIA/RECOVERY KNOWLEDGE
& SKILLS CHECKLIST_
Email: records@nns-ic.com

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