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PACU RN
PACU RN
Name
*
Full Name
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
Cardiovascular
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Doppler
Assessment - Pulses/circulation
Assist with arterial line insertion
Assist with central line insertion
Care of patient - Aneurysm
Care of patient - Hypertension
Care of patient - Hypotension
Care of patient - Post cardiac cath
Care of patient - Post cardiac surgery
Care of patient - Thrombophlebitis
Monitoring - A-line (radial)
Monitoring - Arrhythmia interpretation
Monitoring - Cardiac output
Monitoring - CVP
Pacemaker - External
Pacemaker - Permanent
Perform - Controlled cardioversion
Perform - CVP line removal
Perform - Set up CVP line
Pulmonary
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Breath sounds
Assessment - Rate and work of breathing
Assist with extubation
Assist with intubation
Assist with removal of chest tube
Assist with setup/insertion of chest tube
Care of patient - Aspiration
Care of patient - Fresh tracheostomy
Care of patient - Laryngospasm
Care of patient - On ventilator
Chest tube - Use of Pleurevac or Thoraclex
Chest tube - Use of water seal drainage system
Establishing an airway
Oxygen therapy and medication delivery via bag and mask
Oxygen therapy and medication delivery via face mask
Oxygen therapy and medication delivery via nasal canula
Oxygen therapy and medication delivery via tent
Oxygen therapy and medication delivery via trach collar
Pulse oximetry
Neurological
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Level of consciousness
Equipment - Hyper/hypothermia blanket
Monitoring - Intracranial pressure
Monitoring - Seizure precautions
Gastrointestinal
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Abdominal/bowel sounds
Care of patient - Colostomy
Medications - Antiemetics
Perform - Gomco/Emerson suction
Perform - Placement of NG tube
Renal/Genitourinary
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Fluid and electrolyte balance
Assessment - Fluid status
Care of patient - Supra-pubic catheter
Perform - Insert and care for Foley
Perform - Insert and care for straight catheter
Trauma
No Experience
Limited Experience
Experienced
Highly Skilled
Care of patient - Hypothermia
Care of patient - Shock, anaphylactic
Third row
Fourth row
Fifth row
Orthopedics
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Circulation checks
Assessment - Skin
Care of patient - Cast
Care of patient - Total hip replacement
Care of patient - Total knee replacement
Equipment - Continuous passive motion (CPM)
Equipment - Support Device - Traction
Pain Management
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Pain level/tolerance
Assist with delivery of anesthesia - Anesthesia toxicity
Assist with delivery of anesthesia - Documentation of anesthesia
Care of patient - Epidural anesthesia/analgesia
Care of patient - Narcotic analgesia
Care of patient - Patient controlled analgesia (PCA)
Respiratory Treatments
No Experience
Limited Experience
Experienced
Highly Skilled
Airway Management - Nasal airway placement
Airway Management - Nasal airway/suctioning
Airway Management - Oral airway placement
Airway Management - Oropharyngeal/suctioning
Airway Management - Tracheostomy/suctioning
Interpret - Arterial blood gases
Perform - Draw arterial blood gas - Arterial line
Perform - Medication delivery - Aerosol setup mask
Perform - Nasal/oral airway removal
Equipment
No Experience
Limited Experience
Experienced
Highly Skilled
Fracture table - Jackson table
Fracture table - Rush table/Skyton table
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