LPN / LVN SKILL CHECKLIST Name: When completing this ckecklist, please indicate your level of proficiency in each area according to the scale below. Place a check mark in box which best describes your expertiese with each skill. The scale is as follows: 1. Not performed 2. Intermitten experience 3. Very experienced. CARDIOVASCULAR 1. Auscultation of heart rate / rhythm 1 2 3 2. Blood pressure 1 2 3 3. Doppler 1 2 3 4. Pulses 1 2 3 5. Circulatory checks 1 2 3 6. CPR 1 2 3 7. ACLS 1 2 3 8. Post abdominal aortic bypass 1 2 3 9. Angina 1 2 3 10.Aneurysm 1 2 3 11.Congestive heart failure 1 2 3 12.Fem-pop bypass 1 2 3 13.Permanent pacemaker 1 2 3 14.Post carotic endarterectomy 1 2 3 15.Post acute MI 1 2 3 16.Post cardiac surgery 1 2 3 17.Thrombophlebitis 1 2 3 18.DVT 1 2 3 19.Administration of post-op cardiac meds 1 2 3 CERTIFICATIONS 1. BLS 1 2 3 2. ACLS 1 2 3 DIABETIC CARE 1. Diabetic Patient Teaching 1 2 3
2. Diabetic Monitoring 1 2 3 3. S/S of Hyper / Hypoglycemia 1 2 3 4. Performing Fingersticks 1 2 3 5. Glucometer use 1 2 3 6. Insulin infusion 1 2 3 7. Regular / Long Acting Insulin 1 2 3 8. Mixing Insulin 1 2 3 9. Calculating Caloric Intake 1 2 3 EXPERIENCE IN PRIMARY AREAS 1. Hospitals 1 2 3 2. Clinics 1 2 3 3. Nursing Homes 1 2 3 4. Home Health 1 2 3 GASTROINTESTINAL 1. Tube feeding administration - Bolus 1 2 3 2. Tube feeding administration - Pump 1 2 3 3. Medication administration via tube 1 2 3 4. Bowel prep 1 2 3 5. G.I. Bleeding 1 2 3 6. Inflammatory Bowel Disease 1 2 3 7. Guaiac testing 1 2 3 8. Assessing nutritional status 1 2 3 9. Enema administration 1 2 3 10.Assessment of bowel incontinence 1 2 3 11.Signs/symptoms of fecal impaction 1 2 3 12.NG tube care 1 2 3 13.Assessment of NG tube placement 1 2 3 14.Colostomy care 1 2 3 15.Assessment of abdomen 1 2 3 16.Assessment of Bowel sounds 1 2 3 17.Post op care - Abdominal surgeries 1 2 3
INTRAVENOUS THERAPY 1. IV certified 1 2 3 2. Peripheral IV insertion 1 2 3 3. IV Dosage Calculation 1 2 3 4. IV Infusion Pumps 1 2 3 5. IV site care 1 2 3 6. Central Line site care 1 2 3 7. Implanted catheter site care 1 2 3 8. Administration of IV Antibiotics 1 2 3 9. Administration of IV Fluids 1 2 3 10.Administration of IV Narcotics 1 2 3 11.Blood draws from Central Lines 1 2 3 12.Blood Draws from Implanted Catheter 1 2 3 13.Blood draws from Peripheral Line 1 2 3 MEDICATION ADMINISTRATION 1. Dosage Calculation -5 RIGHTS 1 2 3 2. Documentation on M.A.R. & pt chart 1 2 3 3. PDR / Drug Book usage 1 2 3 4. Narcotic Wastage / Verification 1 2 3 5. Drug Action/Interaction knowledge 1 2 3 6. Generic Drug Equivalents 1 2 3 7. Swallowing Precautions 1 2 3 8. Ear Drops 1 2 3 9. Eye Drops 1 2 3 10.Intradermal meds 1 2 3 11.Intramuscular meds 1 2 3 12.Oral meds 1 2 3 13.Parenteral meds 1 2 3 14.Sublingu al meds 1 2 3 15.Topical meds 1 2 3 NEUROLOGICAL
1. Neuro checks 1 2 3 2. Seizure precautions 1 2 3 3. Dementias 1 2 3 4. Neuromuscular disease 1 2 3 5. CVA 1 2 3 6. DTs 1 2 3 7. Aneurysm precautions 1 2 3 8. Anticonvulsants 1 2 3 9. Antispasmodics 1 2 3 10.Long term spinal cord injuries 1 2 3 11.Pain control measures 1 2 3 12.Post craniotomy care 1 2 3 13.Meningitis 1 2 3 14.TENS unit 1 2 3 ORTHOPEDIC 1. Circulation assessment 1 2 3 2. Gait assessment 1 2 3 3. Range of motion 1 2 3 4. Continuous passive motion 1 2 3 5. Cervical collars 1 2 3 6. Gait belts 1 2 3 7. Canes / crutches 1 2 3 8. Slings 1 2 3 9. Brace application 1 2 3 10.Traction application 1 2 3 11.Transfer Boards 1 2 3 12.Walkers 1 2 3 13.Wheelchairs 1 2 3 14.Prosthesis 1 2 3 15.Casts and care 1 2 3 16.Amputation care 1 2 3
17.Post-arthroscopy care 1 2 3 18.Pinned fractures 1 2 3 19.Osteoporosis 1 2 3 20.Care of total hip replacements 1 2 3 21.Care of total knee replacements 1 2 3 22.Rheumatic / Arthritic disease 1 2 3 OTHER SKILLS 1. Charting systems 1 2 3 2. 24 hr written & verbal reporting 1 2 3 3. CODE status; ie Full Code or DNR 1 2 3 4. Accident & Incident reporting 1 2 3 5. Using the 911 system in LTC setting 1 2 3 6. Regulatory guidelines related to residents rights in LTC setting. 1 2 3 7. Regulatory guidelines related to prevention of neglect and abuse of residents 1 2 3 PAIN MANAGEMENT 1. Pain "level" assessment 1 2 3 2. Documentation of Characteristics of pain ie: Location, Duration, character 1 2 3 3. Document effectiveness of pain meds 1 2 3 PSYCHOSOCIAL 1. Assessment & documentation of any behavioral problems. 1 2 3 2. Assess & document signs & symptoms of depression. 1 2 3 3. Assess & document patients response to psychotropic medications. 1 2 3 4. Assess & document effectiveness of all psychiatric meds patient is given. 1 2 3 5. Assess & document effectiveness of all groups and therapy. 1 2 3 6. Parameters for restraint use in LTC 1 2 3 PULMONARY 1. Airway management 1 2 3 2. Apnea monitor 1 2 3 3. Differentiate Breath Sounds 1 2 3 4. Chest tube care 1 2 3 5. Chest physiotherapy 1 2 3
6. Incentive spirometry 1 2 3 7. Inhaler use 1 2 3 8. Tracheal/nasotracheal suctioning 1 2 3 9. Oropharangeal suctioning 1 2 3 10.Oxygen therapy 1 2 3 11.Pulse Oximetry 1 2 3 12.Postural drainage & percussion 1 2 3 13.Pulmonaide use 1 2 3 14.Sputum specimen collection 1 2 3 15.Tracheostomy care / suctioning 1 2 3 16.Ventilator patient care 1 2 3 UNIVERSAL PRECAUTIONS / INFECTION CONTROL 1. AIDS / HIV 1 2 3 2. Hepatitis 1 2 3 3. MRSA 1 2 3 4. VRE 1 2 3 5. Fever management 1 2 3 6. Decubitus/Wound care (contaminated) 1 2 3 7. Reverse Isolation 1 2 3 8. Standard / Universal Precautions 1 2 3 9. Linen: Transporting, storing, handling A. Clean 1 2 3 B. Solid 1 2 3 C. Personal clothing 1 2 3 10.Double bagging technique 1 2 3 11.Proper disposal of sharps and waste 1 2 3 URINARY / RENAL 1. Assessment & care of AV shunt 1 2 3 2. Post renal surgery 1 2 3 3. Renal Failure 1 2 3 4. ESRD 1 2 3 5. Assessment of urinary incontinence 1 2 3
6. Assess I & O 1 2 3 7. Signs & symptoms of UTI 1 2 3 8. Signs & symptoms of distended bladder 1 2 3 9. Indwelling catheter insertion - Female 1 2 3 10.Indwelling catheter insertion - Male 1 2 3 11.Straight Cath -Male 1 2 3 12.Straight Cath - Female 1 2 3 13.Suprapubic catheter care 1 2 3 14.Urine dipsticks for Ketones 1 2 3 15.Urine dipsticks for UTI 1 2 3 WOUNDS, PRESSURE S ORES, S KIN IMPAIRMENTS 1. Assessment and care of Post Op wounds 1 2 3 2. Assessment, prevention and care of pressure wounds. 1 2 3 3. Assessment and documentation of skin conditions and wounds. 1 2 3 4. Sterile dressing changes 1 2 3 5. Aseptic dressing changes 1 2 3 6. Wound irrigation 1 2 3 7. Use of wound care products 1 2 3 8. Beds - Air fluidized, low air loss beds 1 2 3 9. Pressure relieving devices 1 2 3 10.Staple removal 1 2 3 11.Suture removal 1 2 3 The information I have given is true and accurate to the best of my knowledge. Please sign and date below. SIGNATURE: (Last 4 digits of your SSN) Reenter your last 4 digits of your SSN: DATE: set