Skills Checklist:
LPN

Skills Checklist – LPN

Assessment of Pain Level/Tolerance*

Administration of Narcotic Analgesia*

PCA Pumps*

IV Conscious Sedation*

Epidural Anesthesia*

This self-evaluation is for assessing your experience in specific clinical areas. This self-evaluation will not be a determining factor in accepting your application to become an employee of Connected Health Care.

0 = Not Applicable
1 = No Experience
2 = Some Experience
3 = Intermittent Experience
4 = Experienced
5 = Very Experienced

AGE SPECIFIC CARE(Required)

	0	1	2	3	4	5
Newborn/Neonatal (birth - 30 days)*
Infant (30 days - 1 year)*
Toddler (1 - 3 years)*
Preschooler (3 - 5 years)*
School Age (5 - 12 years)*
Adolescents (12 - 18 years)*
Young Adults (18 - 39 years)*
Middle Adults (39 - 64 years)*
Older Adults (64+ years)*

CLINICAL AREAS(Required)

	0	1	2	3	4	5
Burn Unit*
Cardiac Care*
Emergency Department*
Intensive Care Unit*
Step Down*
Gynecology*
Labor and Delivery*
Medical*
Mother/Baby*
Neurology*
Nursery*
Obstetrics*
OR*
Oncology*
Orthopedics*
Pediatrics*
Post Partum*
Psychiatry*
Rehabilitation*
Renal/Dialysis*
Respiratory*
Surgical*
Telemetry*
Doctor's Office*
Health Department*
Corrections*
Home Health*
Long Term Care*
Hospice*
Respite Care*
Outpatient Clinic*
Nursing Home*

CORE SKILLS(Required)

	0	1	2	3	4	5
Admissions of a Patient*
Transfer of a Patient*
Discharge of a Patient*
Assist with Emergency Sitations/Codes*
Vital Signs*
Post Mortem Care*
Assist with Defibrillation*
Assist with Cardioversion*
Documentation*
Patient and Family Education*
Assessment of Abuse*
Restraints*
Body Mechanics*
Aseptic Technique*
Isolation Precautions*

CARDIOVASCULAR - CARE OF PATIENT WITH:(Required)

	0	1	2	3	4	5
Auscultation (rate, rhythm)*
Blood Pressure/Non-invasive*
Doppler*
Heart Sounds/Murmurs*
Abdominal Aortic Aneurysm/Bypass*
Angina*
Cardiac Arrest*
Cardiomyopathy*
Carotid Endarterectomy*
Congestive Heart Failure*
Femoral-Popliteal Bypass*
Myocarditis*
Status Post MI*
Post Angioplasty*
Post Cardiac Cath*
thrombophlebitis*
Temporary Pacemaker*
Permanent Pacemaker*
Cardiac Enzymes*
Blood Chemistries*
Basic Arrhythmia Interpretation*
Lead Placement*

PULMONARY - CARE OF PATIENT WITH:(Required)

	0	1	2	3	4	5
Ventilator/Weaning*
Breath Sounds*
Rate and Work of Breathing*
Arterial Blood Gases (ABG)*
Asthma*
COPD*
Tracheostomy*
Lobectomy*
Pneumonectomy*
Pneumonia*
Pulmonary Embolism*
Thoracotomy*
Tuberculosis*
Pulmonary Edema*
Pneumothorax*
Laryngospasm*
Endotracheal Tube/Suctioning*
Nasal Airway/Suctioning*
Oropharyngeal/Suctioning*
Sputum Specimen Collection*
Tracheostomy/Suctioning*
Assist with Intubation*
Assist with Thoracentesis*
Chest Tube Management*
Chest Physiotherapy*
Incentive Spirometry*
Pulse Oximetry*
Bag and Mask*
Face Mask*
Nasal Cannula*
Portable O2 Tank*

NEUROLOGICAL - CARE OF PATIENT WITH:(Required)

	0	1	2	3	4	5
Glascow Coma Scale*
Level of Consciousness*
Assist with Lumber Puncture*
Use of Hypo-Hyperthermia Blanket*
Aneurysm Precautions*
Basal Skull Fracture*
Closed Head Injuries*
Coma*
CVA*
TIA*
Delirium Tremens*
Encephalitis*
Meningitis*
Neuromuscular Disorders*
Psychiatric Disorders*
Seizures*
Overdose*
Guillain-Barre Syndrome*
Externalized VP Shunts*
Post Craniotomy*
Spinal Cord Injuries*

ORTHOPEDICS - CARE OF PATIENT WITH:(Required)

	0	1	2	3	4	5
Circulation Checks*
Gait*
Range of Motion*
Skin*
Wheelchair Use*
Cane/Crutches/Walker Use*
Amputation*
Arthroscopic Surgery*
Cast*
Splint*
Knee Immobilizer*
Osteoporosis*
Pinned Fractures*
Total Joint Replacements*
Continuous Passive Motion Devices*
Cervical Collar*
Prosthetics*
Traction- Bucks/Skeletal*
Auto Transfuser*

GASTROINTESTINAL - CARE OF PATIENT WITH(Required)

	0	1	2	3	4	5
Abdominal/Bowel Sounds*
Fluid Balance*
Placement of NG Tube*
Placement of Flexible Feeding Tube*
Administration of Tube Feeding*
Feeding Pumps*
Gravity Feeding*
Salem Sump to Suction*
Care of Gastrostomy Tube*
Colostomy Care*
Bowel Obstruction*
GI Bleeding*
Gi Surgery*
Hepatitis*
Inflammatory Bowel Disease*
Liver Failure*
Liver Transplant*
Paralytic Ileus
Colostomy/Ileostomy
Abdominal Trauma*

RENAL/GENITOURINARY - CARE OF PATIENT WITH:(Required)

	0	1	2	3	4	5
Fluid Balance*
Urinary Output*
BUN & Creatine*
Catheter Care*
Specimen Collection- Routine*
Specimen Collection- 24 Hours*
Specimen Collection- Clean Catch*
Insertion & Care of Straight and Foley Catheters- Female*
Insertion & Care of Straight and Foley Catheters- Male*
Hemodialysis*
Nephrectomy*
Peritoneal Dialysis*
Renal Failure*
Renal Transplant*
TURP*
Ileal Conduit*
Bladder Irrigations*
Urinary Tract Infections*
Gyn Surgery*
Renal Trauma*

ENDOCRINE/METABOLIC - CARE OF PATIENT WITH:(Required)

	0	1	2	3	4	5
S/S Diabetic Coma*
S/S Insulin Coma*
Blood Glucose Monitoring*
Performing Finger/Heel Stick*
Sliding Scale Insulin Protocols*
Adrenal Disorders (Addison's)*
Diabetic Mellitus*
Diabetes Insipidus (Pituitary Disorder)*
Diabetic Ketoacidosis*
Hyperthyroidism*
Hypothyroidism*
Thyroidectomy*

WOUND MANAGEMENT(Required)

	0	1	2	3	4	5
Asses Skin for Impending Breakdown*
Surgical Wound Healing*
Sterile Dressing Change*
Wound Vac*
Wet to Dry Dressing*
First Degree Burns*
Second Degree Burns*
Third Degree Burns*
Decubitus Ulcers*
Surgical Wounds with Drains*
Gunshot Wound*
Stab Wound*
Lacerations*
Abrasions*

ONCOLOGY - CARE OF PATIENT WITH:(Required)

INFECTIOUS DISEASE- CARE OF PATIENT WITH:(Required)

INTRAVENOUS THERAPY(Required)

	0	1	2	3	4	5
Site Assessment*
Administration of Blood & Blood Products*
Drawing Blood from a Central Line*
IV Insertion*
Heplock Flushes*
Administration of IV Fluid*
Administration of IV Piggy Back*
Administration of IV Push Medications*
Access VAD*
Central Line*
Peripheral Line*
Administration TPN/Lipids*

PAIN MANAGEMENT(Required)

MISCELLANEOUS(Required)

	0	1	2	3	4	5
Computerized Charting*
Automated Med. Dispensing Systems*
Safe Needle Devices*
PO Medications*
IM Injections*
SQ Injections*
Z- Track Injections*
Rectal Suppositories*
Nasal Sprays*
Ear Drops*
Eye Drops*
Inhalers*
Assist with Emergency Drugs/Code Cart*

Name

First Last

Date

Specialty

By Signing this, I am authorizing that the information I have given is true and accurate to the best of my knowledge. I hereby authorize Connected Health Care to release this Skills Checklist to staffing clients of Connected Health Care. Submit this skills evaluation with your initial application.

Signature(Required)

	0	1	2	3	4	5
Bone Marrow Transplant*
Inpatient Chemotherapy*
Leukemia*
Radiation Implant*
Lymphoma*
Depressed Immune System*
Radiation Therapy*
Fresh Oncology Surgery*

	0	1	2	3	4	5
HIV*
MRSA*
C. Difficile*
VRE*
Hepatitis*
Influenza*
Isolation Precautions*