Post Anesthesia Care Unit (PACU) Skills Self Evaluation

This profile is for assessing your experience in specific clinical areas. This profile will not be a determining factor in accepting
your 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
Respiratory 1 2 3 4 Meds/IV Therapy. 1 2 3 4
Assess Respiratory Status Administer PO Medications
Assess Lung Sounds Administer NG/GT Medications
Airway Maintenance - Jaw Thrust Administer IM & SQ Meds
Airway Maintenance - Chin Lift Peripheral IV Insertion
Insertion of Oral Airway Mix IV Infusion w/ Additives
Insertion of Nasal Airway Administer IV Medications
Removal of Nasal & Oral Airway Use of Heparin/Saline Locks
Administration of Oxygen: 1 2 3 4 Needle-less Systems
Nasal Cannula Infusion Pumps
Face Masks(With/Without Mist) Discontinue Peripheral IV's
Non-Rebreather Mask Know Anesthetic Agents, Complications and Treatment 1 2 3 4
Trach Collar Inhalants
Face Tent Injectables
Incentive Spirometry Narcotics
Suctioning - Nasotracheal Reversal Agents
Suctioning - ETT or Trach Muscle Relaxants
Suctioning - Oropharyngeal Local Anesthesia
Ventilate with Ambu-bag Regional Anesthesia
Assist with Intubation (ETT) Epidural Anesthesia
ETT - Measure Cuff Pressures Spinal Anesthesia
ETT - Determine Air Leaks Intrathecal Anesthesia
Pulse Oximetry AntiEmetic Drugs
Draw ABGs - Arterial Puncture Cardiac 1 2 3 4
Draw ABGs - Arterial Line Auto BP Monitor (NIBP)
Interpret ABGs Use of Cardiac Monitors
Pressure Ventilators Interpretation of Arrhythmias
Volume Ventilators Assist with Code
End Tidal CO2 Monitor Defibrillation/Cardioversion
Troubleshoot Ventilator Alarms Care of Patient with: 1 2 3 4
Charting Respirations w/ Ventilator Permanent Pacemaker
Weaning from Ventilator Temporary Pacemaker
ETT Extubation Cardiogenic Shock
Chest Percussion Hypothermia
Chest Tubes Hyperthermia
Identify & Troubleshoot Airway Problems: 1 2 3 4 Malignant Hyperthermic Crisis
Displaced ETT Care of Post-Op Cardiac Surgery
Upper Airway Obstruction Use of Warming Blankets
Bronchospasm
Vascular 1 2 3 4
Aspiration
Draw Venous Blood (Peripheral)
Pneumothorax
Hemothorax Draw Blood from Central Line
Care of Post-Op Thoracic Surgery Interpretation of Lab Results
Care of Post-Op ENT Surgery Intake and Output
Vascular Cont. 1 2 3 4 Orthopedic Care of Patient with Cont. 1 2 3 4
Peripheral Pulses Continuous Passive Motion (CPM)
Ultrasonic Doppler Skeletal Traction
Identify & Troubleshoot Vascular Problems: 1 2 3 4 Amputation
Edema/Fluid Overload Arthroscopy/Arthrotomy
Hypovolemia Total Hip Replacement
Total Knee Replacement
Admininster Blood/Blood Products: 1 2 3 4
Packed RBCs
Gastrointestinal 1 2 3 4
Assess Bowel Sounds
Whole Blood Assess GI Distress/Bleeding
Plasma/Albumin Insertion/Monitoring NG Tube
Cryoprecipitate Abdominal Wounds
Fluid Resuscitation (Crystalloids) Wound Drains
Care of Patient with: 1 2 3 4 Enterostomy Care
Central Venous Catheter (CVL) Care of Post-Op Abd Surgery
Arterial Line Care of Liver Transplant
Hickman/Broviac Catheters Genitourinary 1 2 3 4
Implantable Venous Port Straight/Foley Cath Female
PICC Line Straight/Foley Cath Male
SwanGanz/Pul Art. Catheter GU Irrigations
Auto Infusion Pump Suprapubic Tube
Assist CVL Insertion Nephrostomy Tube
Assist Arterial Line Insertion Care of Patient with: 1 2 3 4
Arterial Line D/C Shunts & Fistulas
Neurology 1 2 3 4 Nephrectomy
Neurological Assessment Renal Transplant
Glascow Coma Scale Mastectomy
Seizure Precautions Hysterectomy
Intracranial Pressure Monitoring Prostate Surgery
Knowledge of Anticonvulsants Age-Appropriate Nursing Care: Ability to adapt care to incorp-
Care of Post-Op Craniotomy orate normal growth and development. Ability to adapt method
Care of Post-Op Ophth. Patient and terminology of client instructions as it relates to the age and
Pain Management 1 2 3 4 comprehension level of the client. Ability to ensure a safe
Pain Assessment & Pain Scale
environment - reflecting specific needs of the client and various
age groups.
Admin of IV Sedation 4
1 2 3
Admin of Narcotic Analgesia
Newborn/Infant (Birth - 1 year)
PCA Pump
Assist w/ Epidural Cath Insertion Toddler (1 - 3 years)
Assess Epidural Anesthesia Level Preschooler (3 - 5 years)
Assess Spinal Anesthesia Level School Age (5 -12 years)
Auto Med Dispense (Pyxis, SureMed) Adolescents (12 - 18 years)
General Nursing 1 2 3 4 Young Adults (18 - 39 years)
Admit & Orient Patients Middle Adults (39 - 64 years)
Discharge/Transfer Patients Older Adults (64+ years)
Supervise Unlicensed Personnel
Other special skills / training (explain):
Pre-operative Care/Preparation
Urine dipstick
Blood Glucose Monitoring
Positioning/Transferring The information I have given is true and accurate to the best of
my knowledge, and I hereby authorize SHC to release this PACU
Restraints Skills Self Evaluation to staffing clients of SHC.
Advance Directives
Postmortem Care
Care of Patient w/ Latex Allergy
Isolation Techniques
Applicant Name & Title (Please Print)
Care of HIV Patient
Care of Multiple Trauma Patient Applicant Signature
Orthopedic 1 2 3 4
Cast Care SHC Representative Signature
Circulation Assessment
Care of Patient with: 1 2 3 4 Date Revised 5/04