PEDIATRIC SKILLS CHECKLIST
Please enter your full legal name as it appears on your Social Security Card.
* - Required Fields
* First Name:      * Last Name:      * Date:   (mm/dd/yyyy)
Job Description: Staff Nurse - RN - Pediatrics
Evaluates, create and implement patient plan of care, and documents all nursing care for pediatric patients. May assists doctors, NP's, PA's, during examinations and procedures. Administers medications within the scope of practice of the registered nurse. Establish patient care goals and provides necessary teaching to patient and family to understand condition, medications, and self-care skills. Requires a minimum of an associate's degree and a license in the state of employment as a registered nurse. Utilizes ones experience and judgment to plan and accomplish goals. Performs a variety of tasks and direct patient care. Reports to a manager or charge nurse of the designated unit.
KEY: For each criteria
Score 1: Two plus years Expert Experience
Score 2: One-Two Years Current Experience
Score 3: Less than one year or Intermittent Experience
Score 4: Theory, no experience

CRITERIA SCORE
1234
CARDIOVASCULAR
Assessment 
Auscultation (rate, rhythm)
Blood pressure/non-invasive
Heart sounds/murmurs
Perfusion
Interpretation of lab results
Arterial blood gases
Hemoglobin & hematocrit
Equipment & procedures 
Basic EKG interpretation
Non-invasive cardiac monitoring
Care of the child with 
Bacterial endocarditis
Cardiac arrest
Cardiomyopathy
Congenital heart defects/disease
Congestive heart failure
Myocarditis
Pericarditis
Post cardiac cath
Post cardiac surgery
Rheumatic fever
Shock
Medication - Digoxin (Lanoxin)
PULMONARY
Assessment 
Breath sounds
Rate and work of breathing
Equipment & procedures 
Airway management devices/suctioning 
            Bulb syringe
            Nasal airway/suctioning
            Oral airway/suctioning
            Tracheostomy/suctioning
Apnea monitor
Chest physiotherapy
Chest tubes
End tidal CO2
Oximeter
Oxygen therapy delivery systems: 
            Face mask
            Hood
            Isolette
            Nasal cannula
            Tent
            Trach collar
Water seal drainage system
Care of the child with 
Asthma
Bronchiolitis (RSV)
Bronchopulmonary dysplasia (BPD)
Cystic fibrosis
Epiglottitis
LTB/croup
Pertussis
Pneumonia
Tonsillitis
Tuberculosis
Medications 
Alupent (Meraproteranol)
Aminophylline (Theophylline)
Isuprel (Isoproterenol)
Ventolin (Albuterol)
NEUROLOGICAL/ORTHOPEDICS
Assessment - level of consciousness 
Equipment & procedures 
Application of splints
Assist with lumbar puncture
Cast
ICP monitoring
Pinned fractures
Traction
Care of the child with 
Battered child syndrome
Closed head trauma
Clubfoot
Encephalitis
Febrile seizures
Meningitis
Multiple sclerosis
Multiple trauma
Near drowning
Neuromuscular disease
Osteogenic sarcoma
Osteomyelitis
Spinal cord injury
Medications 
Clonazepam (Klonopin)
Corticosteroids
Dilantin (Phenytoin)
Phenobarbital
Tegretol (Carbamazepine)
Valium (Diazepam)
GASTROINTESTINAL
Assessment 
Abdominal
Nutritional
Interpretation of lab results - Serum electrolytes:
Equipment & procedures 
Feedings 
            Bottle
            Breast
            Central hyperalimentation
            Gavage
            Peripheral hyperalimentation
Gastrostomy/button
I-tubes
Jejunal feeding
NG and sump tubes to suction
Penrose drains
Placement of naso/orogastric tube
Wound irrigation/dressing change
Care of the child with 
Anal fissure
Cleft lip/palate
Colostomy
Diaphragmatic hernia
Failure to thrive (FTT)
Gastroenteritis/dehydration
GE reflux
GI bleeding
Ileostomy
Intestinal parasites
Necrotizing enterocolitis (NEC)
Pyloric stenosis
Surgical abdomen
Ulcerative colitis
RENAL/GENITOURINARY
Assessment - fluid balance 
Interpretation of lab results 
            BUN & creatinine
            Urinalysis
Equipment & procedures 
            Assist with suprapubic tap
            Catheter insertion
            Catheter care 
                        Female
                        Male
                        Straight
            Collection of urine specimen
Care of the child with 
Circumcision
Glomerularnephritis
Hemodialysis
Hemolytic uremic syndrome (HUS)
Hypospadias
Ileal conduit ureteral
Infantile polycystic disease
Kidney transplant
Nephrotic syndrome
Peritoneal dialysis
Renal failure
Urinary tract infection
Wilm's tumor
ENDOCRINE/METABOLIC
Assessment 
Interpretation of lab results 
            Blood glucose
            Thyroid studies
Equipment & procedures 
            Blood glucose testing: type
Care of the child with 
Adrenal disorders
Cushing's syndrome
Juvenile diabetes
Pituitary disorders
Thyroid malfunction
Medications
Growth hormone
Insulin
Thyroid
HEMATOLOGY/ONCOLOGY
Assessment of nutritional status 
Interpretation of lab results 
            Blood chemistry
            Blood counts
Equipment & procedures - reverse isolation 
Care of the child with 
            Anemia
            Bone marrow transplant
            Depressed immune system
            Disseminated intravascular coagulation (DIC)
            Hemophilia
            Hodgkin's disease
            Infectious mononucleosis
            Leukemia
            Malignant tumors
            Sickle cell anemia
            Spleen trauma/splenectomy
Medications 
            Chemotherapy certification?
            Prednisone
MEDICATION ADMINISTRATION FOR CHILDREN
Calculation of pediatric doses
Eye/ear installations
Knowledge of emergency drugs
Knowledge of routine pediatric drugs
Metered dose inhaler
PHLEBOTOMY/IV THERAPY
Equipment & procedures 
Administration of blood/blood products 
            Cryoprecipitate
            Packed red blood cells
            Whole blood
Drawing blood from central line
Drawing venous blood
Starting IVs
Angiocath
Butterfly
Heparin lock
Care of the child with 
Central line/catheter/dressing 
            Broviac
            Groshong
            Hickman
            Portacath
            Quinton
            Cutdown line/dressing
            Peripheral line/dressing
INFECTIOUS DISEASES
Interpretation of lab results - blood count 
Equipment & procedures 
            Fever management
            Isolation
Care of the child with 
            AIDS
            Common childhood - communicable diseases
            Cytomegalo virus (CMV)
            Hepatitis
            Kawasaki disease
            Lyme disease
MISCELLANEOUS
Assessment 
            Normal growth and development
            Normal laboratory values
            Recognize signs of abuse or neglect
Medication - immunization schedule
Care of the child with 
            Anorexia/bulimia
            Craniofacial reconstruction
            Depression
            ENT surgery
            Eye surgery
            Ingestion of foreign body
            Ingestion of poison or toxins
            Plastic surgery
            Suicidal threats/actions
WOUND MANAGEMENT
Assessment 
            Skin for impending breakdown
            Stasis ulcers
            Surgical wound healing
Equipment & procedures 
1st degree burns (throughout body)
2nd degree burns
3rd degree burns
Pressure sores
Staged decubitus ulcers
Sterile dressing changes
Surgical wounds with drain(s)
Traumatic wound care
Use of air fluidized, low airloss beds
Wound care/irrigations
PAIN MANAGEMENT
Assessment of pain level/tolerance 
Care of the child with 
            Epidural anesthesia/analgesia
            IV conscious sedation
            Narcotic analgesia
  
Pediatric experience is primarily in: (Please indicate number of years.) 
Medical years
Surgical years
Telemetry years
Orthopedics years
Oncology years
Neurology years
Psychiatry years

AGE SPECIFIC CARE
Please indicate the frequency with which you provide care for each age group inthis specialty area. 1234
Infant (Birth to 1 year)
Toddler (1-3 years)
Pre-school (3-6 years)
School Age (6-12 years)
Adolescent ( 12-18 years)
Young Adult ( 18-30 years)
Mature Adult (30-60 years)
Elderly (>60 years)

JCAHO: I acknowledge and understand JCAHO's list of "Do Not Use Abbreviations" : Yes No
The information I have given is true and accurate to the best of my knowledge. I have read and fully understand the job description. By signing below or submitting electronically, I attest that the information provided within this skills checklist represents a full and complete disclosure of information, and is true and correct to the best of my knowledge and belief. I hereby authorize Sagent Healthstaff to release this skills checklist to client facilities for employment purposes.
* I agree with the above statements. : Yes
* Signature: (please type your full name) :
* Date: (mm/dd/yyyy) :