Operating Room RN Skills Assessment Today's Date MM slash DD slash YYYY Name* First Last Email* Phone Number*General Survey, Part 1Adrenalectomy 0 1 2 3 Appendectomy 0 1 2 3 Bowel Repairs/Resections 0 1 2 3 Cholecystectomy 0 1 2 3 Colectomy 0 1 2 3 Colostomy/Ileostomy 0 1 2 3 Esophagoscopy 0 1 2 3 Esophageal Resection 0 1 2 3 Gastrectomy 0 1 2 3 Gastric Bypass/Stapling 0 1 2 3 Gastroscopy 0 1 2 3 Hemorrhoidectomy 0 1 2 3 Hepatic Resection 0 1 2 3 Herniorrhaphy (Femoral/Inguinal) 0 1 2 3 Herniations (Hiatal,Diaphragm) 0 1 2 3 Laparascopy 0 1 2 3 Laparotomy 0 1 2 3 Mastectomy 0 1 2 3 General Survey, Part 2Nephrectomy 0 1 2 3 Nissen Fundoplication 0 1 2 3 Pancreatectomy 0 1 2 3 Portal/Caval Shunt 0 1 2 3 Splenectomy 0 1 2 3 Transabdominal 0 1 2 3 Vagotomy / Pyloraplasty 0 1 2 3 Whipple Procedure 0 1 2 3 NeurologicalBurr Holes 0 1 2 3 Craniotomy: Tumor 0 1 2 3 Craniotomy: Aneurysm 0 1 2 3 Craniotomy: Trauma 0 1 2 3 Cranioplasty 0 1 2 3 Cervical Fusion 0 1 2 3 Cervical Laminectomy 0 1 2 3 Crutchfield Tong Insertion 0 1 2 3 Hypophysectomy 0 1 2 3 Lumbar Laminectomy 0 1 2 3 Meningocele Repair 0 1 2 3 Shunt Insertions 0 1 2 3 ThoracicBronchoscopy 0 1 2 3 Chest Tubes 0 1 2 3 Esophageal Repair 0 1 2 3 Mediastinoscopy 0 1 2 3 Pneumonectomy 0 1 2 3 Thoracic Aortic Aneurysm 0 1 2 3 OrthoArthroscopy - Knee 0 1 2 3 Arthroscopy - Shoulder 0 1 2 3 Cast Application 0 1 2 3 External Fixations 0 1 2 3 ORIF - Upper Extremity 0 1 2 3 ORIF - Lower Extremity 0 1 2 3 Foot Procedures / Fractures 0 1 2 3 Hand Surgery / Fx Repairs 0 1 2 3 I M Rods 0 1 2 3 Spinal Fusion 0 1 2 3 Total Hip Replacement 0 1 2 3 Total Knee Replacement 0 1 2 3 CardiovascularAngioplasty 0 1 2 3 Aortic Aneurysm 0 1 2 3 Aortic Balloon Insertion 0 1 2 3 Aortic Valve Replacement 0 1 2 3 Carotid Endarterectomy 0 1 2 3 Coronary Artery Bypass 0 1 2 3 Fem-Popliteal Bypass Graft 0 1 2 3 Mitral Valve Replacement 0 1 2 3 Pacemaker Insertion 0 1 2 3 Pediatric Cardiac Procedures 0 1 2 3 Pericardectomy 0 1 2 3 Septal Defects 0 1 2 3 Vein Harvest 0 1 2 3 Ventricular Aneurysm 0 1 2 3 A-V Shunts 0 1 2 3 Coronary Artery Bypass Graft-on pump 0 1 2 3 Coronary Artery Bypass Graft-off pump 0 1 2 3 TransplantBone - Harvest/Transplant 0 1 2 3 Eye - Harvest/Transplant 0 1 2 3 Heart - Harvest/Transplant 0 1 2 3 Liver - Harvest/Transplant 0 1 2 3 Lung - Harvest/Transplant 0 1 2 3 Pancreas - Harvest/Transplant 0 1 2 3 Renal - Harvest/Transplant 0 1 2 3 Skin - Harvest/Transplant 0 1 2 3 PlasticsAbdominalplasty 0 1 2 3 Facelifts 0 1 2 3 Mammoplasty 0 1 2 3 Muscle Flaps 0 1 2 3 Rhinoplasty 0 1 2 3 Septoplasty 0 1 2 3 Skin Grafts 0 1 2 3 OB/GYNAbdominal Hysterectomy 0 1 2 3 A & P Repair 0 1 2 3 C - Section 0 1 2 3 Colposcopy 0 1 2 3 Dilation & Curettage 0 1 2 3 Laparoscopy 0 1 2 3 Marshall Marchetti 0 1 2 3 Suction Curettage 0 1 2 3 Tubal Ligation 0 1 2 3 Vaginal Hysterectomy 0 1 2 3 Vulvectomy 0 1 2 3 OpthamologicalCataract 0 1 2 3 Detached Retina 0 1 2 3 Iridotomy 0 1 2 3 LASIK 0 1 2 3 Orbit/Globe Fractures 0 1 2 3 UrologyCystoscopy 0 1 2 3 Hydrocelectomy 0 1 2 3 Lithotripsy 0 1 2 3 Penile Prosthesis 0 1 2 3 Prostatectomy 0 1 2 3 TURP 0 1 2 3 Vasectomy 0 1 2 3 Ear, Nose, ThroatAcoustic Neuroma 0 1 2 3 Cleft Lip / Palate Repair 0 1 2 3 Endoscopic Sinus Surgery 0 1 2 3 Ethmoidectomy 0 1 2 3 Laryngectomy 0 1 2 3 Mandibular Fractures 0 1 2 3 Mastoidectomy 0 1 2 3 Maxillary Fractures 0 1 2 3 Myringotomy / PE Tubes 0 1 2 3 Neck Dissection 0 1 2 3 Orbital/Zygomatic Fractures 0 1 2 3 Parathyroidectomy 0 1 2 3 Reduction Nasal Fracture 0 1 2 3 Stapedoctomy 0 1 2 3 Ear, Nose, Throat, Part 2T & A 0 1 2 3 Thyroidectomy 0 1 2 3 Tracheostomy 0 1 2 3 Tympanoplasty 0 1 2 3 EquipmentAquamatic K Thermia Unit 0 1 2 3 Argon Beam Coagulator 0 1 2 3 Arthroscopy Cameras 0 1 2 3 Blood Warmer 0 1 2 3 Bovie Electrosurgical Unit 0 1 2 3 Cardiac Monitor-Defibrillator 0 1 2 3 Cell Saver 0 1 2 3 Centrifuge 0 1 2 3 Cry-Ophthalmic Unit 0 1 2 3 Dermatome 0 1 2 3 Dual Tract Lights 0 1 2 3 Drills 0 1 2 3 Ethylene Oxide Sterilizer 0 1 2 3 Fiber Optic Luminator 0 1 2 3 Fluid Pumps 0 1 2 3 Kiddie Pneumatic Tourniquet 0 1 2 3 Lasers 0 1 2 3 Nerve Stimulator 0 1 2 3 Operating Microscope 0 1 2 3 Pleur-e-vac Units 0 1 2 3 Shavers 0 1 2 3 Stapling Instrument 0 1 2 3 Suction Unit Disposable 0 1 2 3 Vac-pac Positioner 0 1 2 3 Ultrasonic Cleaner - AMSCO 0 1 2 3 Washer Sterilizer - AMSCO 0 1 2 3 Flash Autoclave 0 1 2 3 Cidex Sterilization 0 1 2 3 Robotics 0 1 2 3 Fracture Tables 0 1 2 3 Video Systems 0 1 2 3 CUSA 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
[9:30 AM] Katie Iglewski
