LDRP RN 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

Automated Med Dispensing Systems

Accudose

Metro

Omnicell

Promanager Rx

Pyxis

N/A

Other Automated Med Dispensing Systems:

Electronic Documentation

CARE OF THE PATIENT W/ PRE-EXISTING CONDITIONS/HIGH RISK OB

Cardiac Disease(Required)

Neurological Disease(Required)

Pregnancy Induced Diabetes Mellitus(Required)

Asthma(Required)

Chronic Hypertension(Required)

Pregnancy-Induced Hypertension(Required)

Infectious Disease(Required)

HBV(Required)

HIV(Required)

Sickle Cell Disease(Required)

RH Incompatibilities(Required)

Hemolytic Anemia(Required)

Collagen Vascular Disease(Required)

Hemorrhage(Required)

Drug Addiction/Withdrawal(Required)

Pyelonephritis(Required)

Abruptio Placenta(Required)

Placenta Previa(Required)

Placenta Acreta(Required)

Preeclampsia(Required)

Eclampsia(Required)

HELLP Syndrome(Required)

DIC(Required)

Premature Labor(Required)

Malpresentations(Required)

Breech(Required)

Transverse Lie/Shoulder(Required)

Face Presentation(Required)

Brow Presentation(Required)

Multiple Gestation(Required)

PROM(Required)

Chorioamnionitis(Required)

Poly/Oligohydramnios(Required)

Prior Tubal Ligation(Required)

VBAC Management/Trial of Labor(Required)

Uterine Rupture(Required)

Incompetent Cervix (Shirodkar Suture/Cerclage)(Required)

Spontaneous Abortions - Complete/Incomplete(Required)

Intrauterine Growth Retardation (IUGR)(Required)

Postdate Pregnancy(Required)

Fetal Demise(Required)

ANTEPARTUM:

Triage of Obstetrical Patients(Required)

Assessment of Birth Plan(Required)

Perform Admission Risk Assessment(Required)

Non-Stress Test (NST)(Required)

Induction of Labor(Required)

Oxytocin Challenge Tests (OCT)(Required)

Assist with Amniocentesis(Required)

Deep Tendon Reflex Checks (DTR's)(Required)

Edema Assessment(Required)

Clonus(Required)

Breathing/Relaxation Techniques(Required)

KNOWLEDGE AND USE OF

Analgesics(Required)

Ritodrine(Required)

Magnesium Sulfate(Required)

Terbutaline(Required)

Indomethacin(Required)

Procardia(Required)

Pitocin(Required)

Cervidil(Required)

Cytotec(Required)

Prostin Suppositories(Required)

Assist with Prostin Gel(Required)

Antibiotics(Required)

Antihypertensives(Required)

Heparin(Required)

Insulin Drips(Required)

Insulin Pumps(Required)

Insulin SC(Required)

AZT/Other Antiviral Medications(Required)

Rhogam(Required)

IV THERAPY/PROCEDURES

Invasive Hemodynamic Monitoring(Required)

Blood/Fluid Warmers(Required)

LABOR ASSESSMENT/PROCEDURES (MATERNAL):

Assist with Sterile Speculum Exam(Required)

Perform Sterile Speculum Exam(Required)

Vaginal Exam - Manual(Required)

Status of Membranes(Required)

Assist with Rupture of Membranes(Required)

Fern Test(Required)

Nitrazine(Required)

Presence of Clonus(Required)

DTR's(Required)

Edema(Required)

Progression of Labor

Assess Station/Dilation/Effacement(Required)

Determine Fetal Position/Presentation(Required)

Contraction Characteristics(Required)

Determination of Fetal Head Position(Required)

Documentation of Labor Status and Interventions(Required)

Labor Suppressants(Required)

COLLECT AND LABEL VAGINAL CULTURES

Fluid(Required)

Herpes(Required)

Chlamydia(Required)

Group B Strep(Required)

Perform Leopold's Maneuvers(Required)

Amnioinfusion (assist or perform) for:(Required)

Variable Decelerations(Required)

Meconium(Required)

Prolapsed Cord(Required)

Vasa Previa(Required)

Catheter Insertion(Required)

LABOR ASSESSMENT/PROCEDURES (Fetal):

Fetal Heart Rate - Doppler(Required)

Fetal Heart Rate - Auscultate(Required)

Fetal Heart Rate Patterns (Identify & Treat):

Variability(Required)

Variable Decelerations(Required)

Early Decelerations(Required)

Late Decelerations(Required)

Prolonged Decelerations(Required)

External Fetal Monitor Application(Required)

Internal Fetal Monitor Application (Assist)(Required)

Internal Fetal Monitor Application (Perform)(Required)

Spiral Electrode(Required)

Intrauterine Pressure Catheter (IUPC)(Required)

Placement(Required)

Calibration(Required)

Fluid Filled(Required)

Transducer Tipped(Required)

DELIVERY/C-SECTION

Assist with Vaginal Delivery(Required)

Forceps Extraction(Required)

Vacuum Extraction(Required)

Assist with High Risk Delivery(Required)

Shoulder Dystocia(Required)

Hemorrhage/Shock(Required)

Emergency Delivery(Required)

Perineal Prep(Required)

Circulate for C-Section(Required)

Scrub for C-Section(Required)

Patient with General Anesthesia(Required)

Patient with Epidural Anesthesia(Required)

Circulate for Tubal Ligation(Required)

Scrub for Tubal Ligation(Required)

Assist with Placenta Delivery(Required)

Assist with Cervical Laceration Repair(Required)

Assist with Uterine Laceration Repair(Required)

Assist with Episiotomy Repair(Required)

IMMEDIATE CARE OF NEWBORN IN DELIVERY ROOM

Newborn Assessment

Ballard(Required)

Dubowitz(Required)

Finnegan/Abstinence Scoring(Required)

Apgar Scores(Required)

Initial Care

Bulb(Required)

Delee(Required)

Wall(Required)

Meconium Aspiration(Required)

Collect Cord Samples(Required)

Assist with UAC/UVC Insertion(Required)

Insertion of IV, Including Scalp IV(Required)

Radiant Warmer/Thermoregulation(Required)

Interventions for LGA, SGA, IUGR(Required)

Interventions for Infant of Diabetic Mother(Required)

Oxygen Administration(Required)

Bag/Mask Ventilation of the Newborn(Required)

Assist with Intubation(Required)

Transport Isolette(Required)

Heelstick Glucose(Required)

POSTPARTUM CARE

Fundal Height(Required)

Fundal Massage(Required)

Lochia(Required)

Episiotomy Care(Required)

Maternal Vital Signs(Required)

Recovering Post-Op C-Section Patient(Required)

Recovering Post-Op Tubal Ligation Patient(Required)

Fluid Balance(Required)

Assessment for DVT(Required)

Couplet Care(Required)

Breastfeeding(Required)

NEWBORN CARE

Cord Care(Required)

Assist with Breastfeeding

Latch on(Required)

Positioning(Required)

CARE OF THE INFANT WITH

Assist with Lumbar Puncture(Required)

Administration of IV Antibiotics(Required)

Drug Addiction/Withdrawal(Required)

Cystic Fibrosis(Required)

Meconium Aspiration(Required)

Pulmonary Edema(Required)

RDS(Required)

NEC(Required)

Cardiac Anomalies(Required)

Neuromuscular Disease(Required)

Spina Bifida(Required)

Seizure Activity(Required)

Tracheoesophageal Fistula(Required)

Sepsis(Required)

Sickle Cell Disease(Required)

Low Birth Weight Infants(Required)

PAIN MANAGEMENT/ANESTHESIA

Assess Pain Level/Acceptable Level of Pain(Required)

Intranasal Pain Medications(Required)

Oral Pain Medications(Required)

IV Pain Medications(Required)

PCA(Required)

IV Moderate/Conscious Sedation(Required)

Epidural Pain Management(Required)

Intervention for Anesthesia Toxicity(Required)

Assist with Epidural Insertion

Positioning of Patient(Required)

Signs of a Dural Puncture(Required)

Coaching Patient(Required)

Fluid Challenge(Required)

Hypotension(Required)

Intrathecal Narcotics(Required)

MY EXPERIENCE

Fetal Monitoring Course - Basic?(Required)

Fetal Monitoring Course - Intermediate?(Required)

Fetal Monitoring Course - Advanced?(Required)

Number of Deliveries per Month (average in last year):

Have you ever experienced an unattended delivery?: