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Pediatric RN
Pediatric RN
Name
First
Last
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 - Auscultation (rate, rhythm, volume)
Assessment - Blood pressure/non-invasive
Assessment - Perfusion
Care of child - Bacterial endocarditis
Care of child - Cardiac arrest
Care of child - Cardiomyopathy
Care of child - Congenital heart defects
Care of child - Congestive heart failure
Care of child - Myocarditis
Care of child - Pericarditis
Care of child - Post cardiac cath
Care of child - Post cardiac surgery
Care of child - Rheumatic fever
Care of child - Shock
Interpret - Arterial blood gases
Interpret - Hemoglobin and hematocrit
Medications - Digoxin
Monitoring - Basic 12 lead interpretation
Monitoring - Cardiac output
Pulmonary
No Experience
Limited Experience
Experienced
Highly Skilled
Airway management - Nasal/suctioning
Airway management - Oropharyngeal/suctioning
Airway management - Tracheostomy/suctioning
Apnea monitor
Assessment - Breath sounds
Assessment - Rate and work of breathing
Care of child - Asthma
Care of child - Bronchiolitis (RSV)
Care of child - Bronchopulmonary dysplasia BPD)
Care of child - Cystic fibrosis
Care of child - Epiglottitis
Care of child - LTB/croup
Care of child - Pertussis
Care of child - Pneumonia
Care of child - Tonsillitis
Care of child - Tuberculosis
Chest tube - Use of Pleurevac or Thoraclex
Chest tube - Use of water seal drainage system
End tidal CO2
Medications - Alupent
Medications - Aminophylline
Medications - Isuprel
Medications - Ventolin
Oxygen therapy and medication delivery via bulb syringe
Oxygen therapy and medication delivery via face mask
Oxygen therapy and medication delivery via isolette
Oxygen therapy and medication delivery via nasal cannula
Oxygen therapy and medication delivery via oxyhood
Oxygen therapy and medication delivery via tent
Oxygen therapy and medication delivery via trach collar
Perform - Chest physiotherapy
Pulse oximetry
Water seal drainage system
Neurological
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Level of consciousness
Assist with lumbar puncture
Care of child - Closed head trauma
Care of child - Encephalitis
Care of child - Febrile seizures
Care of child - Meningitis
Care of child - Multiple sclerosis
Care of child - Near drowning
Care of child - Neuromuscular disease
Care of child - Spinal cord injury
Gastrointestinal
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Abdominal/bowel sounds
Care of child - Cleft lip/palate
Care of child - Colostomy
Care of child - Failure to thrive (FTT)
Care of child - Gastroenteritis/dehydration
Care of child - GI bleeding
Care of child - Necrotizing enterocolitis (NEC)
Care of child - Pyloric stenosis
Care of child - Surgical abdomen
Care of child - Ulcerative colitis
Equipment - Penrose drains
Feedings - Bottle
Feedings - Breast
Feedings - Gastrostomy/button
Feedings - Gavage
Perform - NG and sump tubes to suction
Perform - Placement of NG tube
Renal/Genitourinary
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Fluid and electrolyte balance
Assist with supra-pubic tap
Care of child - Glomerularnephritis
Care of child - Hemodialysis
Care of child - Hemolytic uremic syndrome (HUS)
Care of child - Ileal conduit urethral
Care of child - Kidney transplant
Care of child - Peritoneal dialysis
Care of child - Renal failure
Care of child - Urinary tract infection
Care of child - Wilms tumor
Interpret - BUN and creatinine
Interpret - Serum electrolytes
Interpret - Urinalysis
Perform - Insert and care for Foley
Perform - Urine specimen collection (routine)
Endocrine/Metabolic
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Fluid and electrolyte balance
Care of child - Adrenal disorder
Care of child - Juvenile diabetes
Care of child - Pituitary disorders
Interpret - Blood glucose
Medications - Insulin
Hematology/Oncology
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Nutritional status
Care of child - Anemia
Care of child - Hemophilia
Care of child - Hodgkin's disease
Care of child - Infectious mononucleosis
Care of child - Leukemia
Care of child - Malignant tumors
Care of child - Sickle cell anemia
Care of child - Spleen trauma/splenectomy
Interpret - Blood counts
Perform - Reverse isolation
Infectious Disease
No Experience
Limited Experience
Experienced
Highly Skilled
Care of child - AIDS
Care of child - Childhood communicable diseases
Care of child - Cytomegalovirus (CMV)
Care of child - Hepatitis
Care of child - Kawasaki disease
Care of child - Lyme disease
Interpret - Blood counts
Perform - Fever management
Perform - Isolation
Orthopedics
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Circulation checks
Assessment - Range of motion
Care of child - Pinned fractures
Equipment - Support device - Traction
Wound Management
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Skin for impending breakdown
Assessment - Surgical wound healing
Care of child - 1st degree burns
Care of child - 2nd degree burns
Care of child - 3rd degree burns
Care of child - Pressure sores
Care of child - Staged decubitis ulcers
Equipment - Air fluidized, low air loss beds
Perform - Sterile dressing change
Perform - Wound care/irrigation
Pain Management
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Pain level/tolerance
Care of child - IV conscious sedation
Care of child - Narcotic analgesia
Care of child - Epidural anesthesia/analgesia
Phlebotomy/IV Therapy
No Experience
Limited Experience
Experienced
Highly Skilled
Care of child - Peripheral line/dressing
Care of child - Portacath
Perform - Administer hyperalimentation/TPN
Perform - Administer packed RBC's
Perform - Draw blood from central line
Perform - Draw venous blood
Perform - Start IV (heparin lock)
Miscellaneous
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Immunization schedule
Assessment - Normal growth and development
Assessment - Recognize signs of abuse or neglect
Care of child - ENT surgery
Care of child - Eye surgery
Care of child - Ingestion of foreign body
Care of child - Ingestion of poison or toxin
Care of child - Plastic surgery
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