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Pediatric Intensive Care

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 Fusion Medical Staffing.

  • 0 = Not Applicable
  • 1 = No Experience
  • 2 = Some Experience
  • 3 = Intermittent Experience
  • 4 = Experienced
  • 5 = Very Experienced
*Required
n/a
1
2
3
4
5

* Required

Age of Patients Cared For

Newborn/Neonate (birth to 30 days)*

Infant (1 month to 1 year)*

Toddler (1 year to 3 years)*

Preschooler (3 years to 5 years)*

School Age Child (5 years to 12 years)*

Adolescents (12 years to 18 years)*

Young Adults (18 years to 39 years)*

General Skills

Standard Precautions*

Isolation Precautions*

Pediatric Respiratory/Cardiac Arrest*

Adult Respiratory/Cardiac Arrest*

Crash Carts*

Defibrillators*

Care of Patient in Restraints*

Automated Med Dispensing Systems*

Care Planning & Discharge Planning*

Patient/Family Education*

Electronic Documentation*

Patient Head to Toe Assessment*

Cardiovascular General Skills

Auscultation (rate, rhythm, volume)*

Blood Pressure/Invasive (arterial line)*

Heart Sounds/Murmurs*

Perfusion*

Central Venous Pressure*

Invasive Hemodynamic Monitoring

Interpretation of Lab Results- CBC/Electrolytes*

Defibrillation/Cardioversion*

EKG Interpretation (Basic & Advanced)*

Cardiovascular - Care of Children With

Bacterial Endocarditis*

Congenital heart Disease/Defects Cardiac Arrest*

Cardiac Transplant*

Cardiogenic Shock*

Cardiomyopathy*

Hypovolemic Shock*

Myocarditis*

Post Cardiac Surgery*

Post Interventional Cardiac Cath*

Cardiovascular - Medications Knowledge and Use Of

Dobutamine (Dobutrex)*

Dopamine (Intropin)*

Epinephrine (Adrenalin)*

Nipride (Nitroprusside)*

Nitroglycerine (Tridil)*

Sodium Bicarbonate*

Antiarrhythmics*

Respiratory General Skills

Breath Sounds/Work of Breathing*

Obtaining Blood Gases

Arterial*

Heelstick*

Peripheral*

Interpretation of ABG’s*

Oximeter*

Airway Management

Assist with Intubation*

Assist with Extubation*

Suctioning

Bulb Syringe*

Nasal Airway/Suctioning*

Oral Airway/Suctioning*

In-Line Suction*

Open ET Catheter Suction*

Tracheostomy/Suctioning*

Apnea Monitor*

Chest Physiotherapy*

Chest Tube (Assist With)

Insertion*

Removal*

ECMO (Extracorporeal Membrane Oxygenation)*

End Tidal CO2*

O2 Therapy

Nasal Cannula*

Bag & Mask*

Isolette*

Oxyhood*

Tent*

Trach Collar*

Thoracentesis*

Ventilators

CPAP/PEEP/BIPAP*

High Frequency Jet Ventilator*

Home Ventilator*

IMV*

Pressure Ventilator*

Volume Ventilator*

Weaning*

Respiratory - Care of Children With

Bronchiolitis (RSV)*

Pneumonia*

Croup*

Chronic Respiratory Disease*

Status Asthmaticus*

Lung Transplant*

Epiglottitis*

Fresh Tracheostomy*

Foreign Body Aspiration*

Flail Chest*

Hemothorax*

Pneumothorax*

Respiratory Distress Syndrome (RDS)*

Respiratory Failure*

Respiratory - Medications Knowledge and Use Of

Steroids*

Bronchodilators*

Racemic Epinephrine*

Neuro General Skills

Glasgow Coma Scale*

Neurological Status*

Assist with Lumbar Puncture*

Seizure Precautions*

Intracranial Pressure Monitoring*

Neuro - Care of Children With

Head Trauma*

Post Neurosurgery*

Spinal Cord Injury*

Status Epilepticus*

Coma*

Brain Death/Organ Procurement*

Encephalitis*

Meningitis*

Externalized VP Shunt/Reservoirs*

Neuromuscular Disease*

Neuro - Medications Knowledge and Use Of

Mannitol*

Sedatives*

Anticonvulsants*

Gastrointestinal General Skills

Abdominal Assessment*

Interpretation of Lab Results- Serum Electrolytes*

Feedings (Storage and Prep of)*

Bottle*

Breast*

Gavage*

TPN*

PPN*

Gastrostomy/Button

J-Tubes*

NG to Suction*

Placement of Naso/Orogastric Tube*

Test for Occult Blood*

Gastrointestinal - Care of Children With

Anal Fissure*

Cleft Lip/Palate*

New Colostomy*

New Ileostomy*

Diaphragmatic Hernia*

Severe Failure to Thrive (FTT)*

Pyloric Stenosis Repair*

GE Reflux*

GI Bleeding*

Crohn’s Disease*

Ulcerative Colitis*

Severe Gastroenteritis/Dehydration*

Intestinal Parasites*

Necrotizing Enterocolitis (NEC)*

Surgical Abdomen*

Liver Transplant*

Small Bowel Transplant*

Gastrointestinal - Medications Knowledge and Use Of

Antiemetics*

Renal/Genitourinary General Skills

Interpretation Of Lab Results (UA/BUN/Creatinine):*

Test Urine and Interpret*

Glucose*

Labstix*

Occult Blood*

pH*

Specific Gravity*

Collection of Urine Specimens

Assist with Suprapubic Tap*

Catheter*

Diaper/Bag*

Insertion & Care Of Straight And Foley Catheter:*

Suprapubic*

Renal/Genitourinary - Care of Children With

Acute Renal Failure*

CAVH*

Peritoneal Dialysis*

Hemodialysis*

Hemolytic Uremic Syndrome (HUS)*

Nephritis*

Nephrotic Syndrome*

Renal Tansplant*

Syndrome Inappropriate ADH (SIADH)*

Endocrine/Metabolic General Skills

Electrolyte Balance*

Blood Glucose Testing*

Knowledge of Lab work-Thyroid Studies*

Endocrine/Metabolic - Care of Children With

Diabetes Mellitus*

Diabetic Ketoacidosis*

Diabetic Coma*

Hyper/Hypocalcemia*

Hyperbilirubinemia*

Thyroid Dysfunction*

Endocrine/Metabolic - Medications Knowledge and Use Of

Growth Hormone*

Insulin*

Thyroid Medications*

Orthopedic General Skills

Specialized Orthopedic Bed*

Orthopedic - Care of Children With

Cervical Traction*

Pinned Fractures*

Post Vertebral Surgery*

Wound Management

Assessment Of Skin Status:*

Stasis Ulcers*

Surgical Wound Healing*

Air Fluidized, Low Airloss Beds*

Sterile Dressing Changes*

Wound Care/Irrigations*

JP*

Penrose*

Hemovac*

Burns

First Degree*

Second Degree*

Third Degree*

Pressure sores*

Staged Decubitus Ulcers*

Surgical Wounds with Drain(s)*

Traumatic Wounds*

Oncology General Skills

Reverse Isolation*

Nutritional Status*

Interpretation Of Lab Result

Blood Chemistry*

Blood Counts*

Oncology - Care of Children With

Malignant Tumors*

Fresh Oncologic Surgery*

Acute Tumor Lysis Syndrome*

Leukemia*

Bone Marrow Transplant*

Disseminated Intravascular Coagulation*

Inpatient Chemotherapy*

Radiation Implant*

Oncology - Medications Knowledge and Use Of

Chemotherapeutic Agents*

Infectious Diseases General Skills

Interpretation Of Lab Results:*

Cultures (Including Sensitivities)*

CBC/differential (shift)*

Obtain Culture Specimens

Blood*

Swab*

Urine*

Sputum*

Infectious Diseases - Care of Children With

Cytomegalovirus (CMV)*

HIV/AIDS*

Septic Shock*

Tuberculosis*

Hepatitis*

Common Childhood Communicable Diseases*

Phlebotomy/IV Therapy

Peripheral IV Insertion, Care and Maintenance*

Central Line Care and Maintenance*

PICC Line Care and Maintenance*

Drawing Blood from Central Line/PICC Line*

Drawing Venous Blood*

Administration Of Blood/Blood Products:*

Cryoprecipitate*

Packed Red Blood Cells*

Whole Blood*

Phlebotomy/IV - Care of Children With

Central Line*

Port-A-Cath*

PICC*

Cutdown Line*

Peripheral Line*

Arterial Line*

Pain Management General Skills

Assessment- Pain Level Using Age Appropriate Scales*

Pain Management - Care of Children With

Epidural Analgesia*

PCA*

IV Conscious Sedation*

Medication Knowledge and Use Of

Analgesics*

Sedatives*

Reversal Agents*

Miscellaneous

Normal Growth And Development:*

Normal Laboratory Values*

Recognize Signs of Abuse or Neglect*

Miscellaneous - Care of Children With

Anorexia/Bulimia*

Craniofacial Reconstruction*

Depression*

HEENT Surgery*

Ingestion of Foreign Body*

Ingestion of Poison or Toxins*

Plastic Surgery*

Suicide Attempt*

Multiple Trauma*

Near Drowning*

Medication Administration for Children

Calculation of Pediatric Doses*

Titration of IV Drips*

Eye/Ear Installations*

Metered Dose Inhaler*

Intravenous Medications (IV)*

Subcutaneous (SQ) Injections*

Z Track Injections*

Knowledge of Emergency Drug Action and Reaction*

Pediatric Drug Actions and Reactions*

Years of Experience in Each of the Following Pediatric Areas

Chemotherapy cert?*

Application Agreement

The information I have given is true and accurate to the best of my knowledge, and I hereby authorize Fusion Medical Staffing to release this Skills Checklist to staffing clients of Fusion Medical Staffing. Submit this skills evaluation with your initial application. To be updated annually.

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