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Pediatric Skills Clinical Competency Assessment

175 E. Olive Avenue Suite 101, Burbank, CA 91502 TEL: 800-554-2230 FAX: 800-554-7501

Review Information

Your Name: Date:

Guidelines Complete this review, using the following scale:

0 = No experience 1 = Infrequent experience 2 = 1 Year consistent experience 3 = 2 years consistent experience 4 = Able to teach and supervise

Please check the column that best describes your level of experience with each skill.

Care of Patient

0 1 2 3 4 Asthma Bone Marrow Transplant Bowel Obstruction Broncho-Pulmonary Dysplasia CHP Cystic Fibrosis Diabetes Mellitus Drug Addiction/Withdrawal Endotracheal Tube Care and Suctioning Failure to Thrive HIV Intracranial Hemorrhage Leukemia Low Birth Weight Infants Meconium Aspiration Meningitis Near Drowning NEC Neuromuscular Disease NG Tube Feeding Overdose/Poison Ingestion PDA Ligation Post Harrington Rod Insertion

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Care of Patient (continued):

Pre/Post Cardiac Surgery Pre/Post Cardiac Cath Pre/Post Neuro Surgery Pre/Post Thoracic Surgery Pulmonary Edema RDS Seizure Activity Sickle Cell Disease Spina Bifida Systematic Infection Tetralogy of Fallot Tracheosophogeal Fistula Tracheostomy Care and Suctioning

Cardiovascular

0 1 2 3 4 Cardiac Drugs Apnea Monitor Assessment of: Chest Exam and Auscultation Abnormal Chest Sounds Chest Circumference Pattern of Breathing Presence of Deformity Prolonged Inspiratory/Expiratory Phase Rales. Rhonci, Wheezing Retractions: Intercostal Subcostal Supraclavicular Tachypnea Extremities: Clubbing of Fingers and Toes Edema Eyes: Periorbital Edema General Appearance: Activity Level Apprehensive and Agitates Height, Weight, Head Circumference Skin: Cyanosis Diaphroesis Duskiness Pallor Vital Signs: Apical Pulse

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Cardiovascular (continued):

Blood Pressure Peripheral Pulse Respirations Cardiac Monitor Cardio-Pulmonary Resuscitation: Of Child Of Infant Child/Infant in Shock Cardiogenic Hypovolemic Septic Acyanotic Heart Disease Care of CV Patient Congestive Heart Failure Cyanotic Heart Disease Disseminated Intravascular Congestion PDA Ligation Digital Scales Interpretation of EKG Rhythm Strips Interpretation of Normal HCT Values Pre/Post Surgery Care Preparation of Emergency Drugs Use of Automatic BP Monitor Use of Doppler Use of Infant Scales

Endocrine

0 1 2 3 4 Assessment: General Appearance Headache Hunger Impaired Hearing Irritability Mood Shakiness Assessment of GI Status Bowel Sounds-Presence and Type Measurement of Abdominal Girth Cramping Pain Rigidity Tenesmus Vomiting Assessment of Hydration

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Endocrine (continued):

L&Q Moistness of Mucous Membranes Skin Turgor Stool Output Stool Testing Blood Glucose Levels via Dextrostix or Chemstirip Calculation of Caloric Needs Fluid Needs Calculation of Dehydration Appendectomy Crohn’s Disease Diabetes Mellitus Diabetic Acidosis Gastroenteritis/Omphalocele Gastroesophagel Reflux Gastroenteritis Inguineal Hernia Colostomy/Ileostomy Care Gastrostomy Tube Gavage Feeding Nasogastric Nasojejunal Hepatitis Hydration Status Dry Skin Excessive Thirst Polyuria Imperforate Anus Insulin Pump Infusion of Insulin Drip Interpretation of Electrolyte Values Kussmaul Respirations Liver Transplant Nasogastric & Sump Tubes Intermittent & Continuous Suctioning Neurological Symptoms Impaired Vision LOC Phototherapy Treatment Pre/Post Op Management Pyloric Stenosis Tracheoesophageal Fistula (TEF)

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General Skills

0 1 2 3 4 Admission Assessment: Children’s Restraints Arm and Leg Jacket Mummy Child Abuse Cleft Palate Failure to Thrive Post Tonsillectomy Terminal Illness Charge Nurse Responsibilities Diabetic Teaching Discharge Teaching Equipment: Air Flow Bed Bed-Elect Crib Isolette Play Room Transilluminator Growth and Development Rate Lab Value Assessment Legal Principles of Charting Opthalmoscopic Exam Otoscopic Exam Pain Management Patient Education Poison Management Primary Nurse Team Leading Universal Precautions

Genitourinary

0 1 2 3 4 Assessment: BP Behavior: Crying on Urination Irritability Lack of Energy Restlessness Genitalia: Discharge Irritation Kidney Function: Ascites

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Genitourinary (continued):

Dysuria Edema (Scrotal, Periobital) Flank Pain Frequency of Incontinence Urgency Voiding Pattern Skin Turgor Urine Clarity Color Odor Assist with Suprapubic Tap Care of Child/Infant With; Disorders of External Organs GU Reflux Hypospadias Repair Ileal Conduit Wilms’ Tumor Care of Shunt/Fistula Hemodialysis Insertion and Care of Foley Catheter Peritoneal Dialysis Pre/Post Op Management Renal Failure: Acute Chronic Renal Transplantation Ureteral Reimplantation Urine Routine: Application of Colleting Bag Aspiration of Diaper Catheter Culture and Sensitivity Specific Gravity Urine Routine Timed

Hematology

0 1 2 3 4 Admin of Blood/Blood Components to: Child Infant Administration of Chemotherapy Administration of Factor VIII Infusions Assist with Bone Marrow Aspiration AIDS Anemia

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Hematology (continued):

Hemophilia Hodgkin’s Disease Idiopathic Thrombocytopenic Purpura Leukemia Post Bone Marrow Transplant Sickle Cell Crisis Isolation: Blood/Body Fluids Contact Drainage/Secretions Enteric Respiratory Strict

IV Therapy

0 1 2 3 4 Bolus Infusions IV Antibiotics IV Chemotherapy Calculate Pediatric Dosages Care of Central Lines Change IV Dressings Heparin Lock Hickman/Broviac Catheters Hyperalimentation Therapy Infusion Pumps PCA/CADD IV Initiation in: Feet Hands PICC Line Insertion Scalp Start Peripheral IV Lines Triple Lumen Catheters

Neurological

0 1 2 3 4 Accurate Documentation of Seizure Activity Administration of Anticonvulsive Meds Assessment of: Affect Fine Motor Function Fontanels (Infants) Gait and Postural Control Gross Motor Function Intellectual Abilities

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Neurological (continued):

Level of Consciousness Orientation Pupil Size and Response Reflex Function Sensory Function Assisting with Lumbar Puncture Closed Head Injury Craniotomy Hydrocephalus Meningitis Reye’s Syndrome Spina Bifida V-P Shunt Glascow Coma Scale Pre/Post Op Management

Orthopedics

0 1 2 3 4 Assistance with Devices (Splints, Braces, Casts) Congenital Dislocation of the Hip Fractures Juvenile Rheumatoid Arthritis Muscular Dystrophy Osteogenic Sarcoma/Amputation Osteomyelitis Post Harrington Rod Insertion Scoliosis Traction: Bryant’s Buck’s Cervical Skeletal Cast Care and Observation Circulation Checks for Neurovascular Assessment Multiple Trauma Pin Care Pre/Post Op Management Trimming Casts Circo-Electric Bed

Respiratory

0 1 2 3 4 Assessment Breathing Pattern

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Respiratory (continued):

Chest Auscultation Breath Sounds Cough Hoarseness Inspiratory/Expiratory Stridor Assisting with Intubation/Extubation Calculation and Admin of Buffer Solutions Sodium Bicarbonate Asthma Broncho-Pulmonary Dysplasia (PDA) Croup Cystic Fibrosis Epiglottis Near Drowning Near SIDS Pneumonia Respiratory Distress Syndrome (RDS) Respiratory Syncytial Virus (RSV) Chest Exam: Chest Circumference Chest Physiotherapy Chest Tube: Assisting with Insertion/Set-up Maintenance Care Collection of Sputum Collection of Culture Specimens: Nasopharyngeal, Stool, Urine General Appearance: Activity Level Behavior Obtaining Blood Gases/Lab Test: Heel Stick Peripheral Artery Line Pulse Oximetry Tracheostomy Care and Suctioning Position of Comfort Presence of Retractions Respirations Sterile Dressing Change Use of Respiratory Assistance Equip. Croup Test Oxygen Analyzer Oxyhood, Nasal Cannula Ventilation with Ambu Bag Ventilators: AC

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Respiratory (continued):

CPAP IMV PEEP

Other

0 1 2 3 4 Assessment of: Rashes Skin: Bleeding Bruises Cyanosis Hematomas Jaundice Mottling Pallor Petechial Wound Healing Burned Child/Infant

Age of Patients Cared for

0 1 2 3 4 Infants and Toddlers (0-3) Young Children (4-6) Older Children (7-12) Adolescents (13-20) Young Adults (21-39) Middle Adults (40-64) Older Adults (65+)

Signature: _________________________________ Date: ________________

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