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Telemetry RN
Telemetry 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)
Assessment - Blood pressure/non-invasive
Assessment - Doppler
Assessment - Heart sounds/murmurs
Assessment - Perfusion
Assessment - Pulses/circulation
Assist with code
Care of patient - Acute MI
Care of patient - Angina
Care of patient - Congestive heart failure
Care of patient - Post angioplasty
Care of patient - Post cardiac surgery
Care of patient - Thrombophlebitis
Medications - Oral and IVP antihypertensives
Medications - Oral and topical nitrates
Medication - Oral anticoagulants
Monitoring - Arrhythmia interpretations
Pulmonary
No Experience
Limited Experience
Experienced
Highly Skilled
Airway Management - Nasal/suctioning
Airway Management - Tracheostomy/suctioning
Airway Management - Breath sounds
Assessment - Rate and work of breathing
Assist with intubation
Assist with removal of chest tube
Assist with setup/insertion of chest tube
Care of patient - COPD
Care of patient - Pneumonia
Care of patient - Pulmonary embolism
Care of patient - Tuberculosis
Chest tube - Use of Pleurevac or Thoraclex
Chest tube - Use of water seal drainage system
Interpret - Arterial blood gases
Interpret - Blood chemistry
Oxygen therapy and medicine delivery via bag and mask
Oxygen therapy and medicine delivery via external CPAP
Oxygen therapy and medicine delivery via trach collar
Perform - Chest physiotherapy
Perform - Obtain sputum specimen
Teach and understand - Incentive spirometry
Neurological
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Glasgow coma scale
Assessment - Level of consciousness
Assist with lumbar puncture
Care of patient - CVA
Care of patient - DT's
Care of patient - Meningitis
Care of patient - Neuromuscular diseases
Care of patient - Seizures
Care of patient - Spinal cord injury
Equipment - Hyper/hypothermia blanket
Medications - Anticonvulsants
Gastrointestinal
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Abdominal/bowel sounds
Assessment - Fluid balance
Assessment - Nutrition
Care of patient - Colostomy
Care of patient - Paralytic ileus
Equipment - Feeding pump
Equipment - Flexible feeding tube (e.g. Corpak)
Interpret - Blood chemistry
Monitoring - T-tube
Perform - Administer tube feeding
Perform - Placement of NG tube
Renal/Genitourinary
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - A-V fistula
Assessment - Fluid and electrolyte balance
Care of patient - Chronic renal failure
Interpret - BUN and Creatinine
Interpret - Serum electrolytes
Perform - Insert and care for Foley
Perform - Urine sample collection (24-hr)
Endocrine/Metabolic
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - S/S diabetic coma
Assessment - S/S insulin reaction
Care of patient - Diabetes mellitus
Medications - Insulin
Medications - Steroids
Perform - Blood glucose monitoring: Finger stick
Infectious Disease
No Experience
Limited Experience
Experienced
Highly Skilled
Care of patient - Hepatitis
Interpret - Blood counts
Perform - Fever management
Perform - Isolation
Orthopedics
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Circulation checks
Assessment - Gait
Assessment - Range of motion
Assessment - Skin
Care of patient - Amputation
Care of patient - Pinned fractures
Equipment - Continuous passive motion (CPM)
Equipment - Support device - Cervical collar
Equipment - Support device - Gait belt
Equipment - Support device - Traction
Wound Management
No Experience
Limited Experience
Experienced
Highly Skilled
Assessment - Skin for impending breakdown
Assessment - Stasis ulcers
Assessment - Surgical wound healing
Care of patient - Staged decubitis ulcers
Care of patient - Surgical wounds with drain(s)
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 patient - Epidural anesthesia/analgesia
Care of patient - IV conscious sedation
Care of patient - Patient controlled analgesia (PCA)
Phlebotomy/IV Therapy
No Experience
Limited Experience
Experienced
Highly Skilled
Care of patient - Central line/catheter/dressing
Care of patient - Peripheral line/dressing
Care of patient - Portacath
Perform - Administer packed RBC's
Perform - Administer plasma/albumin
Perform - Draw blood from central line
Perform - Draw venous blood
Perform - Start IV (heparin lock)
Signature
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