LVN/LPN Skills Assessment Today's Date: MM slash DD slash YYYY Name* First Last Email* Phone Number*Respiratory, Part 1Assessment of Breath Sounds 0 1 2 3 Administer O2 (NC, Mask) 0 1 2 3 Assist with Intubation 0 1 2 3 Ventilate with Ambu-bag 0 1 2 3 Suctioning 0 1 2 3 Use of ETT CO2 detectors 0 1 2 3 Assist with Extubation 0 1 2 3 Use of Pressure Ventilators 0 1 2 3 Use of Volume Ventilators 0 1 2 3 Weaning Patient from Ventilator 0 1 2 3 Use of IMV 0 1 2 3 Use of CPAP 0 1 2 3 Use of PEEP 0 1 2 3 Use of Assist-control 0 1 2 3 Use of Blow-by 0 1 2 3 Troubleshoot Ventilator Problems 0 1 2 3 Pulse Oximetry 0 1 2 3 Perform Arterial Puncture 0 1 2 3 Respiratory, Part 2Perform Arterial Puncture 0 1 2 3 Draw Blood from Arterial Line 0 1 2 3 Interpret Arterial Blood Gases 0 1 2 3 Assist with Chest Tube Insertion 0 1 2 3 Assist with Thoracentesis 0 1 2 3 Assist with Bronchoscopy 0 1 2 3 Assist with Cricothyroid Airway 0 1 2 3 Isolation Techniques 0 1 2 3 Postmortem Care 0 1 2 3 Pre-operative Care/Preparation 0 1 2 3 Post-anesthesia Care 0 1 2 3 NeurologicalNeuro Assessment/ Vital Signs 0 1 2 3 Glasgow Coma Scale 0 1 2 3 Assist with Lumbar Puncture 0 1 2 3 Intracranial Pressure Monitoring 0 1 2 3 Seizure Precautions 0 1 2 3 Aneurysm Precautions 0 1 2 3 Use of Rotating Bed 0 1 2 3 Use of Stryker Frame 0 1 2 3 Epidural Medication Admin 0 1 2 3 Assist with Insertion and SetupArterial Lines 0 1 2 3 Central Venous Catheter 0 1 2 3 Pulmonary Artery Catheter 0 1 2 3 Pericardiocentesis 0 1 2 3 Placement of External Pacemaker 0 1 2 3 Intra-aortic Balloon (IABP) 0 1 2 3 Care of Patient with:Chest Injury 0 1 2 3 Hemo/Pneumo 0 1 2 3 Tracheostomy 0 1 2 3 ECMO 0 1 2 3 ARDS 0 1 2 3 Pulmonary Edema 0 1 2 3 Lung Transplant 0 1 2 3 Assess Respiratory Complications 0 1 2 3 Emergency Medication AdministrationEpinephrine 0 1 2 3 Atropine 0 1 2 3 Lidocaine 0 1 2 3 Bretylium 0 1 2 3 Bicarbonate 0 1 2 3 TPA 0 1 2 3 Vaso-active Drips: 0 1 2 3 Dopamine 0 1 2 3 Nipride 0 1 2 3 Nitroglycerin 0 1 2 3 Inocor 0 1 2 3 Dobutamine 0 1 2 3 RenalAcute Renal Failure 0 1 2 3 Chronic Renal Failure 0 1 2 3 Hemodialysis 0 1 2 3 Peritoneal Dialysis 0 1 2 3 Renal Transplant 0 1 2 3 AV Fistula 0 1 2 3 GastrointestinalAssessment of Bowel Sounds 0 1 2 3 Identification of Abnormalities 0 1 2 3 Insert / Maintain Feeding Tubes 0 1 2 3 Insert/Maintain NG tubes 0 1 2 3 Care of Patient with:GI Bleed 0 1 2 3 Esophageal Hemorrhage 0 1 2 3 Acute Pancreatitis 0 1 2 3 Open Abd Wound/Incision 0 1 2 3 Peritoneal Lavage 0 1 2 3 Abdominal Aortic Aneurysm 0 1 2 3 Medication Administration, Part 1Moderate/Conscious Sedation 0 1 2 3 Sedation Reversal Agents 0 1 2 3 Antibiotics IM/IV 0 1 2 3 Antiemetics 0 1 2 3 Adenosine 0 1 2 3 Aminophylline(Theophylline) 0 1 2 3 Atropine 0 1 2 3 Anticoagulants 0 1 2 3 Anticonvulsants 0 1 2 3 Antihypertensives 0 1 2 3 Barbituate Induced Coma 0 1 2 3 Charcoal 0 1 2 3 Cardizem 0 1 2 3 Cordarone 0 1 2 3 Decadron 0 1 2 3 Dopamine 0 1 2 3 Medication Administration, Part 2Diuretics 0 1 2 3 Epinephrine 0 1 2 3 Heparin Drip protocol 0 1 2 3 Inotropes (Digoxin,Dobutamine,Primacor) 0 1 2 3 Inocor 0 1 2 3 Insulin Infusions 0 1 2 3 Intrathecal Medication 0 1 2 3 Isuprel 0 1 2 3 Kayexelate 0 1 2 3 Lidocaine 0 1 2 3 Mannitol 0 1 2 3 Nitroglycerin 0 1 2 3 Nipride 0 1 2 3 Steroids 0 1 2 3 Thrombolytic Therapy 0 1 2 3 Vasopressin 0 1 2 3 Ventolin (Albuterol) 0 1 2 3 CardiovascularAssessment of Heart Sounds 0 1 2 3 Use of Cardiac Monitors 0 1 2 3 Identify Lethal Dysrhythmias 0 1 2 3 Telemetry 0 1 2 3 Perform 12-lead EKG 0 1 2 3 Basic 12-Lead Interpretation 0 1 2 3 Assist with Code 0 1 2 3 Defibrillation/Cardioversion 0 1 2 3 Cardiac Arrest / CPR 0 1 2 3 Assist with Open Chest Procedure 0 1 2 3 Continuous Cardiac Monitoring 0 1 2 3 Myocardial Contusion 0 1 2 3 Care of Patient with:Acute MI 0 1 2 3 Congestive Heart Failure 0 1 2 3 Pre/post Cardiac Cath 0 1 2 3 Pre/post Cardiac Surgery 0 1 2 3 Cardiac Tamponade 0 1 2 3 Aneurysm 0 1 2 3 Permanent Pacemaker 0 1 2 3 Temporary Pacemaker 0 1 2 3 Intra-aortic Balloon Pump (IABP) 0 1 2 3 Automatic Implanted Defibrillator 0 1 2 3 Heart Transplant 0 1 2 3 Cardiogenic Shock 0 1 2 3 Septic Shock 0 1 2 3 Hypovolemic Shock 0 1 2 3 DIC 0 1 2 3 Ventricular Assist Device 0 1 2 3 Vascular Surgeries 0 1 2 3 Fresh Open Heart Surgery 0 1 2 3 Open Heart Surgery ( more than 6 hrs. post-op) 0 1 2 3 EP Study and Ablation 0 1 2 3 Obtain/Interpret Hemodynamic MeasurementsCentral Venous Pressure 0 1 2 3 Arterial Pressure (MAP) 0 1 2 3 PA Pressure 0 1 2 3 PCW Pressure 0 1 2 3 Cardiac Output (thermodilution) 0 1 2 3 SVO2 0 1 2 3 Intervene PA Catheter Problems 0 1 2 3 Obtain ABG 0 1 2 3 Obtain Mixed Venous Gases 0 1 2 3 OTHER, Care of Patient with:Multiple Trauma 0 1 2 3 Burns 0 1 2 3 Oncology 0 1 2 3 Chemotherapy 0 1 2 3 AIDS 0 1 2 3 Ketoacidosis 0 1 2 3 Bone Marrow Transplant 0 1 2 3 Liver Transplant 0 1 2 3 Open/Closed Head Injury 0 1 2 3 Acute CVA 0 1 2 3 Spinal Cord Injury 0 1 2 3 Craniotomy 0 1 2 3 Increased ICP 0 1 2 3 Cerebral Aneurysm 0 1 2 3 Halo Traction/Cervical Tongs 0 1 2 3 Degenerative Diseases of CNS 0 1 2 3 CNS Infections 0 1 2 3 Drug Overdose / DTs 0 1 2 3 Age of Patients Cared for:Newborn (birth-30 days) 0 1 2 3 Infant (30 days - 1 year) 0 1 2 3 Toddler (1 - 3 years) 0 1 2 3 Preschooler (3 - 5 years) 0 1 2 3 School Age (5 - 12 years) 0 1 2 3 Adolescents (12 - 18 years) 0 1 2 3 Young Adults (18 - 39 years) 0 1 2 3 Middle Adults (39 - 64 years) 0 1 2 3 Older Adults (64+ years) 0 1 2 3 Candidate SignatureSignature of*
[9:30 AM] Katie Iglewski
