Respiratory Therapy Skills Checklist

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1 – 2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Full Name(Required)

Email(Required)

Send to(Required)

AGE OF PATIENTS CARED FOR

Newborn/ Neonate (birth to 30 days)(Required)

Infant (31 days to 12 months)(Required)

Toddler/Preschool (13 months to 5 years)(Required)

School Age Child/adolescent (6 years to 18 years)(Required)

Young Adults Middle Adult (19 years to 64 years)(Required)

Older Adults/Elderly (65+ years)(Required)

GENERAL SKILLS

Electronic Documentation

SETTINGS

Adult Critical Care(Required)

Pediatrics/PICU(Required)

Neonatal ICU(Required)

Emergency Room(Required)

Home Health(Required)

Sleep Lab(Required)

Pulmonary Rehabilitation(Required)

Transports (Air/Ambulance)(Required)

MEDICATIONS

Advair(Required)

Aerobid(Required)

Albuterol(Required)

Atropine(Required)

Atrovent(Required)

Amphotericin(Required)

Anectine(Required)

Artificial Surfactant(Required)

Bicarbonate(Required)

Colistin(Required)

Cremolyn Sodium (Intal)(Required)

Corticosteroids(Required)

Digitalis(Required)

Digoxin(Required)

Dopamine(Required)

Duoneb(Required)

Foradil(Required)

Flonase(Required)

Flovent(Required)

Inhaled Steroids(Required)

Isotharine (Bronkosol)(Required)

Isuprel(Required)

Lidocaine(Required)

Morphine(Required)

Metaproterenol (Alupent)(Required)

Maxair(Required)

Mycomyst(Required)

Nipride(Required)

Pavulon(Required)

Pulmicort (Budesonide)(Required)

Pulmozyme (Dornase Alfa)(Required)

Racemic Epinephrine (Vaponephrine)(Required)

Ribaviran(Required)

Terbutaline Sulfate (Bricanyl)(Required)

Theo-dur(Required)

Tilade(Required)

Tobramycin(Required)

Valium(Required)

Xopenex(Required)

Xylocaine(Required)

CARE OF PATIENTS WITH

Aspiration Pneumonia(Required)

ARDS(Required)

Asthma(Required)

Status Asthmaticus(Required)

Acute/Chronic Bronchitis(Required)

Bronchopulmonary Dysplasia (BPD)(Required)

Bacterial/Viral Pneumonia(Required)

Bronchiectasis(Required)

Bronchiolitis(Required)

Croup(Required)

Cystic Fibrosis(Required)

Cardiac Surgery(Required)

Diabetic Ketoacidosis(Required)

Epiglottitis(Required)

Emphysema(Required)

Empyema(Required)

Failure to Thrive(Required)

Guillian Barre(Required)

Hyaline Membrane Disease(Required)

Lung Cancer(Required)

Meconium Aspiration(Required)

Myesthenia Gravis(Required)

Myocardial Infarction(Required)

Near Drowning(Required)

Neonatal Pneumonia(Required)

Pacemakers(Required)

Persistent Fetal Circulation(Required)

Pneumothorax(Required)

Pulmonary Interstitial Emphysema (PIE)(Required)

Pulmonary Edema(Required)

Pulmonary Emboli(Required)

Transient Tachypnea of the Newborn(Required)

Transesophageal Fistula(Required)

Thoracotomy(Required)

Tuberculosis(Required)

THERAPEUTICS AND PROCEDURES

Nasal(Required)

Masks(Required)

Trach(Required)

Aerosol Set-up/Mask/Trach(Required)

Aerosol Heated/Cool(Required)

Oxygen Tank Set-up(Required)

Croup Tent Set-up/Troubleshoot(Required)

Infant Hood Set-up(Required)

Analyze Oxygen(Required)

Intubate Adult(Required)

Intubate Infant(Required)

Assist with Intubation(Required)

Extubate(Required)

Assist with Extubation(Required)

Assist with High Risk Delivery(Required)

Nasotracheal Suction(Required)

Endotracheal Suction(Required)

Ventilate Patient with Manual Resuscitator(Required)

Check Intracuff Pressures(Required)

Change/Clean Trach Tubes(Required)

Oral Airway Placement(Required)

Nasal Airway Placement(Required)

Isolation Procedures(Required)

Disinfection & Sterile Techniques(Required)

Incentive Spirometry(Required)

IPPB(Required)

Hand Held Nebulizers(Required)

Ultrasonic Nebulizer(Required)

Chest Physiotherapy/Postural Drainage(Required)

Splinting(Required)

Medihaler(Required)

Inhaler Reservoirs (Inspirease/Aerochamber)(Required)

Pursed Lip Breathing(Required)

Diaphragmatic Breathing(Required)

Segmental Breathing(Required)

Ventilator Set-up(Required)

Troubleshoot Ventilators(Required)

Ventilator Set-up(Required)

Negative Inspiratory Force(Required)

Vital Capacity(Required)

Nasal CPAP(Required)

BiPap nasal/mask(Required)

Assist/Control(Required)

Control(Required)

CPAP(Required)

IMV(Required)

SIMV(Required)

PEEP(Required)

High-Frequency Ventilator(Required)

Inverse Ratio Ventilation(Required)

Pulmonary Stress Testing(Required)

Pulmonary Function Testing(Required)

Bedside Screening(Required)

Peak Flow Rate(Required)

Apnea Monitor(Required)

Oximetry(Required)

Transcutaneous Monitoring(Required)

Assist with Bronchoscopies(Required)

ARTERIAL BLOOD GASES

Allen Test(Required)

Analyzing(Required)

Interpretation(Required)

Arterial Line(Required)

Radial/Brachial Artery(Required)

Femoral Artery(Required)