Dialysis RN

Name*
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Email
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Date
MM slash DD slash YYYY
Self-Assessment Rating Scale:
No Experience
Theory or observation only during the past 12 months

Limited Experience
Performed less than 12 times within the past 12 months and may need a review

Experienced
Performed at least once per month within the past 12 months and may need minimal assistance

Highly Skilled
Performed on at least a weekly basis over the past 12 months; proficient

Renal/Genitourinary

	No Experience	Limited Experience	Experienced	Highly Skilled
Assessment - A-V Fistula
Assessment - Fluid and Electrolyte Balance
Assessment - Fluid Status
Assessment - Renal/GU System
Assist With Supra-Pubic Tap
Care of Child - Acute Renal Failure
Care of Child - CAVH
Care of Child - Diabetes Insipidus
Care of Child - Glomerulanephritis
Care of Child - Hemodialysis
Care of Child - Hemolytic Uremic Syndrome (HUS)
Care of Child - Illeal Conduit Urethral
Care of Child - Infantile Polycystic Disease
Care of Child - Kidney Transplant
Care of Child - Nephrotic Syndrome
Care of Child - Peritoneal Dialysis
Care of Child - Renal Failure
Care of Child - SIADH
Care of Patient - Acute Renal Failure
Care of Patient - CAVH Dialysis
Care of Patient - Chronic Renal Failure
Care of Patient - Hemodialysis
Care of Patient - Illeal Conduit
Care of Patient - Nephrectomy
Care of Patient - Nephrostomy Tube
Care of Patient - Peritoneal Dialysis
Care of Patient - Peritoneal Lavage
Care of Patient - Renal Rejection Syndrome
Care of Patient - Renal Transplant
Care of Patient - Renal Trauma
Care of Patient - Supra-Pubic Catherter
Care of Patient - Tunneled/Non-Tunneled Catheter
Care of Patient - Urinary Tract Infection
Insert and Care for 3-way Foley
Insert and Care for Supra-Pubic Catheter
Interpret - BUN and Creatinine
Interpret - Serum Electrolytes
Interpret - Urine Analysis
Perform - Insert and Care for Foley
Perform - Manual CAPD Administration
Perform - Peritoneal Dialysis Via Automatic Cycler
Perform - Urine Specimen Collection (24-hr)

Hemodialysis

	No Experience	Limited Experience	Experienced	Highly Skilled
Acute/Inpatient Dialysis
Assess Patient/Equipment During Dialysis - Administration of Blood Products
Assess Patient/Equipment During Dialysis - Administration of Mannitol
Assess Patient/Equipment During Dialysis - Arterial and Venous Pressures
Assess Patient/Equipment During Dialysis - Blood Flow Rate
Assess Patient/Equipment During Dialysis - Conductivity
Assess Patient/Equipment During Dialysis - Documentation of Dialysis Treatment
Assess Patient/Equipment During Dialysis - Management of Anticoagulation
Assess Patient/Equipment During Dialysis - Operation of Myron L. Meter
Assess Patient/Equipment During Dialysis - Sequential Ultrafiltration/UPF
Assess Patient/Equipment During Dialysis - Subjective Response to Treatment
Assess Patient/Equipment During Dialysis - Systems Assessment of Patient
Assess Patient/Equipment During Dialysis - Ultrafiltration Calculation
Assess Patient/Equipment During Dialysis - Vascular Access Function
Assess Patient/Equipment During Dialysis - Volume Status
Chronic/Outpatient Dialysis
Discontinue Dialysis - Dialysis Catheter
Discontinue Dialysis - Equipment Clean Up
Discontinue Dialysis - Fistula/Vein Graft
Discontinue Dialysis - Post Treatment Access Care
Discontinue Dialysis - Return of Blood
Discontinue Dialysis - Sterilization Procedures
Machine Alarm/Troubleshooting - Air/Foam Detector Alarm
Machine Alarm/Troubleshooting - Arterial Pressure Alarm
Machine Alarm/Troubleshooting - Blood Leak Alarm
Machine Alarm/Troubleshooting - Blood Pump Alarm
Machine Alarm/Troubleshooting - Conductivity Alarm
Machine Alarm/Troubleshooting - High Temperature Alarm
Machine Alarm/Troubleshooting - Ultrafiltration Alarm
Machine Alarm/Troubleshooting - Venous Pressure Alarm
Management of Patient With - Air Embolus
Management of Patient With - Anemia
Management of Patient With - Cardiopulmonary Arrest
Management of Patient With - Chest Pain
Management of Patient With - Clotted Access/Poor Blood Flow Rate
Management of Patient With - Disequilibrium Syndrome
Management of Patient With - Filter Blood Leak
Management of Patient With - Fluid Overload
Management of Patient With - Hemolysis
Management of Patient With - Hyperkalemia
Management of Patient With - Hypertension
Management of Patient With - Hypotension
Management of Patient With - Muscle Cramps
Management of Patient With - Neuropathy
Management of Patient With - Pericarditis
Management of Patient With - Pyrogenic Reaction
Management of Patient With - Seizures
Pediatric Dialysis
Pre-Dialysis Nursing Assessment
Setup/Initiate Dialysis Treatment - Anticoagulation
Setup/Initiate Dialysis Treatment - Bicarbonate Dialysate
Setup/Initiate Dialysis Treatment - Check for Machine/Alarm Settings
Setup/Initiate Dialysis Treatment - Collect Blood Specimens
Setup/Initiate Dialysis Treatment - Conductivity Testing
Setup/Initiate Dialysis Treatment - Dialysis
Setup/Initiate Dialysis Treatment - Fistula Gortex/Bovine Graft
Setup/Initiate Dialysis Treatment - Prep Vascular Access
Setup/Initiate Dialysis Treatment - Priming Dialyzer
Teaching Dialysis to Patient and Family

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