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PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE &

SKILLS CHECKLIST
NAME:       b. Apnea monitor
ID #:       c. Chest Tube (assist with)
DATE:      
DIRECTIONS: Please indicate your level of
experience by placing a check (√) in the
This Skills Checklist is for use by nurses box. Experience level:
with more than one year experience in 1 NO EXPERIENCE
their discipline and specialty. Please be 2 MINIMAL EXPERIENCE-requires
accurate with your assessment. supervision/assistance
3 MODERATELY EXPERIENCED-requires
initial review, then performs
DESCRIPTION 1 2 3 4 independently
NEUROLOGICAL: 4 VERY EXPERIENCED- proficient
1. Assessment:
a. Intracranial pressure
monitoring DESCRIPTION 1 2 3 4
b. Neurological status (1) Insertion
2. Equipment & Procedures: (2) Removal
a. Brain death/organ (3) Set-up
procurement d. Obtaining blood gases:
b. Externalized VP Shunt/reservoirs (1) Arterial
c. Coma (2) Heelstick
d. Encephalitis (3) Peripheral
e. Head Trauma (4) Pulse oximeter
f. Meningitis e. O2 therapy & medication delivery:
g. Neuromuscular disease (1) Bag and mask
h. Post Neurosurgery (2) Isolette
i. Spinal Cord Injury (3) Nasal cannula
j. Status Epilepticus (4) Nebulizer
3. Medication (5) Oxyhood
a. Anticonvulsant medication (6) Tent
b. Mannitol (7) Trach collar
c. Pavulon f. Thoracentesis
PULMONARY i. Ventilator care:
1. Assessment: (1) CPAP/PEEP
a. Breath sounds (2) IMV
b. Rate and work of breathing (3) High frequency jet
2. Equipment & procedures: ventilation
a. Airway management (4) Pressure ventilator
(1) Assist with intubation (5) Weaning
(2) bulb syringe 3. Care of the patient with:
(3) Endotracheal tube a. Bronchiolitis (RSV)
suctioning b. Severe respiratory distress
(4) Extubation c. Chronic respiratory disease
(5) Nasal airway/suctioning d. Epiglottitis
(6) Oral airway/suctioning e. Foreign Body aspiration
(7) Tracheostomy/suctioning f. Fresh tracheostomy
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PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE &
SKILLS CHECKLIST
g. Hemothorax i. Potassium Chloride
h. Croup e. Sodium bicarbonate
i. Pneumonia ORTHOPEDICS
j. Pneumothorax 1. Equipment & Procedures
a. Specialized orthopedic bed
Name:       2. Care of child with:
DESCRIPTION 1 2 3 4 a. Cervical traction
k. RDS b. Pinned fractures
l. Respiratory failure
m. Status asthmaticus ID #:      
5. Medications: DESCRIPTION 1 2 3 4
a. Aminophylline (Theophylline) c. Post vertebral surgery
b. Prostaglandin GASTROINTESTINAL
CARDIOVASCULAR 1.Assessment:
1. Assessment: a. Abdominal
a. Auscultation (rate, rhythm, b. Nutritional
volume) 2. Equipment & procedures:
b. Blood pressure/invasive a. Abdominal decompression
(arterial line) devices
d. Heart sounds/murmurs b. Feedings:
2. Equipment & procedures: (1) Assist with breast feeding
a. EKG interpretation (2) Bottle
b. Non-invasive cardiac c. Placement of Intestinal tubes:
monitoring (1) Gastrostomy/button
c. Invasive hemodynamic (2) Jejunal
monitoring (3) Nasogastric/Orogastric
(1) Pulmonary artery/capillary e. Test of occult blood
wedge 3. Care of the child with:
(2) Cardiac output/index a. Fresh Ostomy
d. Central venous pressure b. Gastroenteritis/severe
3. Care of the child with: dehydration
a. Cardiac arrest c. GI Reflux
b. Congenital heart d. GI Bleeding
disease/defects e. Hepatic failure
c. Cardiomyopathy f. Hepatitis
d. Hypovolemic shock g. Post Abdominal surgery
e. Myocarditis h. Surgical abdomen
f. Post cardiac surgery RENAL/GENITOURINARY
4. Medications: 1. Assessment of fluid balance
a. Dobutamine 2. Equipment & Procedures:
b. Digoxin a. Collection of urine specimens:
c. Dopamine (1) Assist with supra-pubic tap
d. Epinephrine (2) Catheter
e. Heparin (3) Diaper/bag
f. Lidocaine b. Insertion & care of straight Foley
g. Nitroglycerine catheter:
h. Nipride (1) Female
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PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE &
SKILLS CHECKLIST
(2) Male c. Drawing blood from central
c. Supra-pubic line
3. Care of the child with: d. Drawing venous blood
a. Acute renal failure e. Hyperalimentation/TPN:
b. Hemodialysis (1) Central
c. Nephritis (2) Peripheral
d. Nephrotic syndrome f. Intralipid
e. Peritoneal dialysis g. Managing IV Therapy:
f. Post renal transplant (1) Discontinuing
(2) Dressing & tubing change
Name:       (3) Site & patency assessment
DESCRIPTION 1 2 3 4
g. Syndrome inappropriate ADH ID #:      
(SIADH) DESCRIPTION 1 2 3 4
ENDOCRINE/METABOLIC h. Starting IVs
1. Assessment of electrolyte 2. Care of the child with:
balance a. Central line/catheter/dressing:
2. Equipment & procedures: (1) Hickman
a. Blood glucose testing type:       (2) Portacath
3. Care of the child with: (3) PICC
a. Diabetic ketoacidosis b. Cutdown
b. Hyper/hypocalcemia c. Percutaneous venous line
c. Hyperbilirubinemia d. Peripheral line/dressing
d. Thyroid dysfunction e. PICC (peripherally inserted central
4. Medication – Insulin drip catheter)
INFECTIOUS DISEASES f. Umbilical artery line
1. Equipment & procedures g. Umbilical venous line
a. Assist with lumbar puncture PAIN MANAGEMENT
B. Isolation techniques 1. Assessment of pain
2. Care of the neonate with: level/tolerance
a. Cytomegalovirus (CMV) 2. Care of the child with:
b. HIV/AIDS a. Epidural anesthesia/analgesia
c. Septic Shock b. IV Conscious sedation
d. Tuberculosis WOUND MANAGEMENT
3. Interpretation of lab results 1. Assessment:
PHLEBOTOMY/IV THERAPY a. Skin for impending breakdown
1. Equipment & procedures: b. Stasis ulcers
a. Administration of blood/blood products c. Surgical wound healing
(1) Packed red blood cells 2. Equipment & procedures
(2) Plasma/albumin a. Air fluidized, low air loss beds
(3) Platelets b. Sterile dressing changes
b. Delivery systems: c. Wound care/irrigations
(1) Implantable venous port 3. Care of the child with:
(2) Percutaneous arterial line a. Burns:
(3) Percutaneous venous line (1) First degree
(4) PICC (peripherally inserted central (2) Second degree
catheters) (3) Third degree
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PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE &
SKILLS CHECKLIST
b. Pressure sores k. Suicidal ideation/attempt
c. Stage Decubitus ulcers 4. Medications:
d. Surgical wounds with drain(s) a. Dosage calculations
e. Traumatic wounds b. Drip calculations
ONCOLOGY c. Knowledge of emergency drug action and
1. Assessment: reaction

a. Nutritional status d. Pediatric drug actions &


b. Pain control reactions
2. Interpretation of lab results: 5. Miscellaneous:
a. Blood chemistry a. Interpretation of lab values:
b. Blood counts (1) Blood Chemistry
(2) Blood hematology
Name:       (3) Blood gases
DESCRIPTION 1 2 3 4
3. Equipment & procedures
a. Reverse isolation ID #:      
4. Care of the child with: COMPUTERIZED CHARTING
b. Disseminated intravascular 1. Cerner
coagulation (DIC) 2. Eclipsys
b. Inpatient chemotherapy 3. Epic
c. Inpatient hospice 4. McKesson
d. Leukemia 5. Meditech
e. Malignant tumors 6. Other:
f. Radiation implant Other:
g. Sickle cell anemia Other:
5. Medication:
a. Chemotherapy certification? Yes
No
MISCELLANEOUS
1. Assessment:
a. Knowledge of normal growth and
development
b. Recognize/report signs of child
abuse/neglect
2. Equipment & procedures:
a. Application of restraints
3. Care of the child with:
a. Anorexia/bulimia
b. Blunt trauma
c. Complex wound care
d. Craniofacial reconstruction
e. ENT surgery
f. Gunshot/open chest
g. Ingestions/overdose
h. Multiple trauma
i. Near drowning
j. Penetrating trauma

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PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE &
SKILLS CHECKLIST

Name:      
MY EXPERIENCE IS PRIMARILY IN:
Please check the boxes below for each
age group for which you have expertise in NEUROLOGY       years
providing age-appropriate nursing care. PULMONARY       years
SURGICAL       years
A. Newborn/Neonatal (birth – 30 days) MEDICAL       years
B. Infant (30 days – 1 year) CARDIAC CARE       years
C. Toddler (1 – 3 years) TELEMETRY       years
D. Preschool (3 – 5 years)
E. School Age Children (5 – 12 years) I HAVE CURRENT CERTIFICATIONS FOR:
F. Adolescent (12 – 18 years)
G. Young Adults (18 – 39 years) TYPE COURSE
H. Middles Adults (40 – 64 years) DATE (MM/DD/YY)
I. Older Adults (64 + years) ARRHYTHMIA      
CRITICAL CARE      
EXPERIENCE WITH AGE GROUPS: ACLS      
1. Able to assess age appropriate BCLS      
behavior, motor skills and physiological TNCC      
norms. NRP      
PALS      
A B C D E F G H I NALS      
BTLS      
CCRN      
2. Able to adapt care according to normal Other            
growth and development. Other            

A B C D E F G H I
The information I have provided in this
knowledge and skills checklist it true and
3. Able to communicate and instruct accurate to the best of my knowledge.
patient according to their age, maturity
and comprehension ability.            
Signature Date
A B C D E F G H I (Written/Electronic)
ID #:      

4. Able to provide a safe environment This skills checklist has been reviewed
according to the specific needs of various and approved by Nicole Bloxham, RN.
age groups.
           
A B C D E F G H I Signature Date
(Written/Electronic)
ID #:      

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PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE &
SKILLS CHECKLIST
Please return to: Northwest Nurse Staffing
Company, PA
ATTN: Records Dept.
Fax: (866) 352-4338

Email: records@nns-ic.com

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