PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE & SKILLS CHECKLIST

NAME:       DIRECTIONS: Please indicate your level of experience by

ID #:       placing a check (√) in the box. Experience level:
DATE:       1 NO EXPERIENCE
2 MINIMAL EXPERIENCE-requires supervision/assistance
This Skills Checklist is for use by nurses with more than 3 MODERATELY EXPERIENCED-requires initial review,
one year experience in their discipline and specialty. then performs independently
Please be accurate with your assessment. 4 VERY EXPERIENCED- proficient

DESCRIPTION 1 2 3 4 DESCRIPTION 1 2 3 4
NEUROLOGICAL: (1) Insertion
1. Assessment: (2) Removal
a. Intracranial pressure monitoring (3) Set-up
b. Neurological status d. Obtaining blood gases:
2. Equipment & Procedures: (1) Arterial
a. Brain death/organ procurement (2) Heelstick
b. Externalized VP Shunt/reservoirs (3) Peripheral
c. Coma (4) Pulse oximeter
d. Encephalitis e. O2 therapy & medication delivery:
e. Head Trauma (1) Bag and mask
f. Meningitis (2) Isolette
g. Neuromuscular disease (3) Nasal cannula
h. Post Neurosurgery (4) Nebulizer
i. Spinal Cord Injury (5) Oxyhood
j. Status Epilepticus (6) Tent
3. Medication (7) Trach collar
a. Anticonvulsant medication f. Thoracentesis
b. Mannitol i. Ventilator care:
c. Pavulon (1) CPAP/PEEP
PULMONARY (2) IMV
1. Assessment: (3) High frequency jet ventilation
a. Breath sounds (4) Pressure ventilator
b. Rate and work of breathing (5) Weaning
2. Equipment & procedures: 3. Care of the patient with:
a. Airway management a. Bronchiolitis (RSV)
(1) Assist with intubation b. Severe respiratory distress
(2) bulb syringe c. Chronic respiratory disease
(3) Endotracheal tube suctioning d. Epiglottitis
(4) Extubation e. Foreign Body aspiration
(5) Nasal airway/suctioning f. Fresh tracheostomy
(6) Oral airway/suctioning g. Hemothorax
(7) Tracheostomy/suctioning h. Croup
b. Apnea monitor i. Pneumonia
c. Chest Tube (assist with) j. Pneumothorax

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 PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE & SKILLS CHECKLIST

Name:       ID #:      

DESCRIPTION 1 2 3 4 DESCRIPTION 1 2 3 4
k. RDS c. Post vertebral surgery
l. Respiratory failure GASTROINTESTINAL
m. Status asthmaticus 1.Assessment:
5. Medications: a. Abdominal
a. Aminophylline (Theophylline) b. Nutritional
b. Prostaglandin 2. Equipment & procedures:
CARDIOVASCULAR a. Abdominal decompression devices
1. Assessment: b. Feedings:
a. Auscultation (rate, rhythm, volume) (1) Assist with breast feeding
b. Blood pressure/invasive (arterial line) (2) Bottle
d. Heart sounds/murmurs c. Placement of Intestinal tubes:
2. Equipment & procedures: (1) Gastrostomy/button
a. EKG interpretation (2) Jejunal
b. Non-invasive cardiac monitoring (3) Nasogastric/Orogastric
c. Invasive hemodynamic monitoring e. Test of occult blood
(1) Pulmonary artery/capillary wedge 3. Care of the child with:
(2) Cardiac output/index a. Fresh Ostomy
d. Central venous pressure b. Gastroenteritis/severe dehydration
3. Care of the child with: c. GI Reflux
a. Cardiac arrest d. GI Bleeding
b. Congenital heart 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 catheter:
g. Nitroglycerine (1) Female
h. Nipride (2) Male
i. Potassium Chloride c. Supra-pubic
e. Sodium bicarbonate 3. Care of the child with:
ORTHOPEDICS a. Acute renal failure
1. Equipment & Procedures b. Hemodialysis
a. Specialized orthopedic bed c. Nephritis
2. Care of child with: d. Nephrotic syndrome
a. Cervical traction e. Peritoneal dialysis
b. Pinned fractures f. Post renal transplant

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 PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE & SKILLS CHECKLIST

Name:       ID #:      

DESCRIPTION 1 2 3 4 DESCRIPTION 1 2 3 4
g. Syndrome inappropriate ADH (SIADH) h. Starting IVs
ENDOCRINE/METABOLIC 2. Care of the child with:
1. Assessment of electrolyte 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 catheter)
4. Medication – Insulin drip f. Umbilical artery line
INFECTIOUS DISEASES g. Umbilical venous line
1. Equipment & procedures PAIN MANAGEMENT
a. Assist with lumbar puncture 1. Assessment of pain level/tolerance
B. Isolation techniques 2. Care of the child with:
2. Care of the neonate with: a. Epidural anesthesia/analgesia
a. Cytomegalovirus (CMV) b. IV Conscious sedation
b. HIV/AIDS WOUND MANAGEMENT
c. Septic Shock 1. Assessment:
d. Tuberculosis a. Skin for impending breakdown
3. Interpretation of lab results b. Stasis ulcers
PHLEBOTOMY/IV THERAPY c. Surgical wound healing
1. Equipment & procedures: 2. Equipment & procedures
a. Administration of blood/blood products a. Air fluidized, low air loss beds
(1) Packed red blood cells b. Sterile dressing changes
(2) Plasma/albumin c. Wound care/irrigations
(3) Platelets 3. Care of the child with:
b. Delivery systems: a. Burns:
(1) Implantable venous port (1) First degree
(2) Percutaneous arterial line (2) Second degree
(3) Percutaneous venous line (3) Third degree
(4) PICC (peripherally inserted central catheters) b. Pressure sores
c. Drawing blood from central line c. Stage Decubitus ulcers
d. Drawing venous blood d. Surgical wounds with drain(s)
e. Hyperalimentation/TPN: e. Traumatic wounds
(1) Central ONCOLOGY
(2) Peripheral 1. Assessment:
f. Intralipid a. Nutritional status
g. Managing IV Therapy: b. Pain control
(1) Discontinuing 2. Interpretation of lab results:
(2) Dressing & tubing change a. Blood chemistry
(3) Site & patency assessment b. Blood counts

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 PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE & SKILLS CHECKLIST

Name:       ID #:      

DESCRIPTION 1 2 3 4 COMPUTERIZED CHARTING
3. Equipment & procedures 1. Cerner
a. Reverse isolation 2. Eclipsys
4. Care of the child with: 3. Epic
b. Disseminated intravascular coagulation (DIC) 4. McKesson
b. Inpatient chemotherapy 5. Meditech
c. Inpatient hospice 6. Other:
d. Leukemia Other:
e. Malignant tumors Other:
f. Radiation implant
g. Sickle cell anemia
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
k. Suicidal ideation/attempt
4. Medications:
a. Dosage calculations
b. Drip calculations
c. Knowledge of emergency drug action and reaction
d. Pediatric drug actions & reactions
5. Miscellaneous:
a. Interpretation of lab values:
(1) Blood Chemistry
(2) Blood hematology
(3) Blood gases

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 PEDIATRIC INTENSIVE CARE NURSING KNOWLEDGE & SKILLS CHECKLIST

MY EXPERIENCE IS PRIMARILY IN:

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

3. Able to communicate and instruct patient according to            

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

Please return to: Northwest Nurse Staffing Company, PA

ATTN: Records Dept.
Fax: (866) 352-4338

Email: records@nns-ic.com

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