GENERAL INFORMATION

Note: * Denotes a required field.

Please enter your full name as it appears on your Social Security Card: First Name   Middle Name   Last Name  * Please enter the Last Four digits of your Social Security Number:  -   -   *       Please check here if you do not hold a valid social security card. Please provide your contact information: Phone Number  * E-mail Address  * Confirm E-mail Address  * Type your e-mail address again above.

This profile is for use by healthcare professionals in the LPN discipline and specialty. It will not be a determining factor for the program.

CHECKLIST INSTRUCTIONS

Please mark your level of experience      1. No theory and/or experience      2. Limited experience/need supervision and/or support      3. Experienced/minimal support needed to perform      4. Proficient/can perform independently

Departments

1

2

3

4

Cardiac Care

Doctor's Office/Clinic

Emergency Room

Labor and Delivery

Medical

Mother/Baby

Long Term Care / Nursing Home

Oncology

Orthopedics

Pediatrics

Psychiatry

Rehabilitation

Telemetry

Infection Control

1

2

3

4

Knowledge of Universal Precautions

Knowledge of Waste Disposal

Proper Disposal of Sharps

Management of Patient in Respiratory Isolation

Care of the Patient in Reverse Isolation

Cleaning of Equipment

Procedures

1

2

3

4

Setup/Instruct Patient in Sitz Bath

Administer:

1

2

3

4

Tap/Saline Enema

Soap Suds Enema

Oil Retention Enema

Fleets Enema

Post Mortem Care

Douches

Perform:

1

2

3

4

Wet to Dry Dressings

Sterile Dressing Changes

Bladder Care

Ostomy Care

NG Tube Feeding

Gastrostomy Tube Feeding

Personal Hygiene/Oral Care

Wound Irrigation

Catherization (Male & Female)

Nasal Suctioning

Oral Suctioning

Management of:

1

2

3

4

Chest Tube

Jejunostomy Tube

Levine Tube

Nephrostomy Tube

Medication and Administration

1

2

3

4

Emergency Medication/Crash Cart

Heparin Lock

Inhalers

Intradermal

Intramuscular Injections

Nasal Drops

Ophthalmic Drops

Ophthalmic Ointments

Oral Medications

Rectal Suppositories

Subcutaneous Injections

Topical Ointments

Track Injections

Vaginal Suppositories

Intravenous

1

2

3

4

Change IV Tubing

Chemotherapy

CVP Line

Discontinuing an IV

Hyperalimentation

IV Push Drugs

Maintain IV Site

Medication Addition

Packed RBC

Piggyback Administration

Plasma

Platelets

Regulate Flow

Serum Albumin

Starting an IV

Whole Blood Administration

Specimen Collection

1

2

3

4

Foley Catheter Specimen

Obtain:

1

2

3

4

Sputum Specimen

Stool Hemocult

Stool Ova/Parasite

Stool Specimen

Urine for Culture

Urine for Specific Gravity

Perform Straight Catherization

Assist with Clean Catch Midstream Urine Specimen

Specimen

Collect 24 hour Urine Specimen

Equipment

1

2

3

4

Humidifiers

Alternate Pressure Mattress

Ambu-Bag

Bed Scale

Blood Glucose Monitors

Corstavac Suction

Egg Crate Mattress

Enteral Pump

Heat Lamp

Heating Pad

Hemovac/Davol Suction Pump

Hoyer Lift

Incentive Spirometer

Infusion Devices (Volumetric Pump)

Pleuravac/Emerson Suction

Use Of:

1

2

3

4

Venturi Mask

Wall Suction

Management Of:

1

2

3

4

Nasal Cannula

Oxygen Mask

Trach Collar

Care of Patient with PCS Pump

Application of TED Hose

ABG Kits

Assist with Setup of Water Seal Suction

Application of:

1

2

3

4

Soft Limb Restraints

Leather Restraints

Posey Restraints

Observation of Patient in Restraints

Documentation of Restraints

Safety Guidelines of Patient in Restraints

Assessment

1

2

3

4

Cardiopulmonary Arrest

Drug/Allergic Reaction

Management of the Patient

Perform:

1

2

3

4

Cardiovascular Assessment

Gastrointestinal Assessment

Genitourinary Assessment

Musculoskeletal Assessment

Neurological Assessment

Respiratory Assessment

AGE- APPROPRIATE CARE: Ability to adapt care to incorpor ate normal growth and development, adapt method and terminology of patient instructions as it relates to the age and comprehension level of the patient, and to ensure a safe environment refle

Age

1

2

3

4

Newborn (birth- 30 days)

Infant (30 days- 1 year)

Toddler (1- 3 years)

Preschooler (3- 5 years)

School Age (5- 12 years)

Adolescents (12- 18 years)

Young Adults (18- 39 years)

Middle Adults (39- 64 years)

Older Adults (64+ years old)

Please read and agree to the statements below by marking the checkbox. You will not be able to submit until you have marked the checkbox. * I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize Hudson Staffing to release this LPN Skills Checklist to the client facilities in relation to consideration of employment as a healthcare professional with those facilities.

Privacy Note: Hudson Staffing will record anonymous electronic information about your connection when you click on the submit button. This information is used for security purposes only. This information will include your IP Address (3.236.51.151) which will be used as a digital signature.