Acute Rehab RN

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

Please rate your experience / frequency within the last year

0 = No Experience / Observed Only

1 = Limited Experience / Rarely Done (<6 times/year)

2 = May Need Some Review / Occasionally Done (1-2 times/month)

3 = Experienced / Frequently Done (daily or weekly)

Please rate your experience / frequency within the last year
0 = No Experience / Observed Only
1 = Limited Experience / Rarely Done (<6 times/year)
2 = May Need Some Review / Occasionally Done (1-2 times/month)
3 = Experienced / Frequently Done (daily or weekly)

MM slash DD slash YYYY

Type Of Facility Experience

TYPE OF FACILITY EXPERIENCE

Age Of Patients Cared For

Newborn/Neonate (birth to 30 days)
Infant (31 days to 12 months)
Toddler/Preschool (13 months to 5 years)
School Age Child/adolescent (6 years to 18 years)
Young Adults/Middle Adult (19 years to 64 years)
Older Adults/Elderly (65+ years)

General Skills

Care of Patient in Restraints
Automated Med Dispensing Systems
Electronic Documentation
IV Pumps
Peripheral IV Insertion, Care and Maintenance
Access/Management of Implanted Ports
Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)
Cardiac Monitoring/Interpretation
PCA/Epidural pumps
Titration of drips
Administration of Blood/Blood Products
Knowledge of "Do Not Use Abbreviations"
Do you have charge/supervisor experience?
Knowledge of current Joint Commission National Patient Safety Goals
Knowledge/familiarity with HCAHPS scores

Neurologic - Care Of Patients With:

Pre/Post Neuro Surgery
Basal Skull Fracture
Closed Head Injuries
Coma
Delirium Tremens
Encephalitis
Meningitis
Spinal Cord Injuries
Seizures
Overdose
Stroke/TIA
Guilliane Barre Syndrome
Alzheimer's Disease
Externalized AV Shunt
Post Craniotomy

Cardiac - Care Of Patients With:

Pre/Post Cardiac Surgery
Cardiac Transplant
Abdominal Aortic Aneurysm/Bypass
Angina
Cardiac Arrest
Cardiomyopathy
Femoral Poplitieal Bypass
Myocarditis
Post Angioplasty/Stent
Thrombophlebitis
CHF
Chest Pain
Post MI
Temporary pacemaker
Permanent pacemaker

Orthopedic - Care Of Patients With:

Total Joint Replacement Procedures
Fractures
Rheumatic/Arthritic Disease
Spinal Fusion
Amputation
Traction Devices
Walking asistants (i.e. Crutches, Walker, Cane)

Respiratory - Care Of Patients With:

Lung Transplant
Bronchoscopy
Lobectomy
Tracheostomy Tube
COPD
Asthma
Pneumonia
Pre/Post Thoracic Surgery
Chest Tubes
Tuberculosis
Pneumonectomy
Pulmonary Embolism
Thoracotomy
Pulmonary Edema
Pneumothorax
Laryngospasm

Gastrointestinal - Care Of Patient With:

Post Abdominal Surgery
Liver Transplant
Pancreas Transplant
Ileostomy
Colostomy
Inflammatory Bowel Disease
Bowel Obstruction
Hepatitis
GI Bleeding
Liver Failure
Paralytic Ileus
Abdominal Trauma

Renal/gu - Care Of Patients With:

Kidney Transplant
Insertion of Catheter (Straight and Foley)
Bladder Irrigations
Peritoneal Dialysis
Hemodialysis
A-V Fistula/Shunt Care
Suprapubic Catheter
Nephrostomy Tube
Nephrectomy
Urinary Tract Infection
Pyelonephritis
Renal Failure
Renal Transplant
TURP
Ileal Conduit
Renal Trauma
Renal Calculi

Endocrine - Care Of Patients With:

Hyperthyroidism
Hypothyroidism
Thyroidectomy
Diabetes Mellitus
Diabetes Insipidus
Diabetic Ketoacidosis

Knowledge And Use Of

Insulin
Single Type
Mixed Insulins
Insulin Infusion

Wound/skin - Care Of Patient With:

Multiple Abdominal Wounds and Drains
Gunshot Wound
Stab Wound
Lacerations
Dressing Changes
Pressure Relief Mattresses
Decubitus Ulcers
Traumatic Wounds
Leg Ulcers
First Degree Burns
Second Degree Burns
Third Degree Burns

Additional Medical/surgical Skills-care Of Patient With

Hemovacs
Jackson-Pratt Drains
Penrose Drains
Surgical Wound Irrigations & Dressings

Infectious Disease - Care Of The Patient With:

HIV
MRSA
CRE
VRE
C. Difficile
Hepatitis
Influenza
Isolation Precautions

Medications

Antibiotics
Antihypertensives
anticoagulants
Anticonvulsants
Narcotics
Digoxin
Diuretics
Steroids
Diltiazem
Antiemetics
Antispasmotics
Oral Hypoglycemics
Inhalers
IV Conscious Sedation
Reversal Agents (Narcan, Romazicon)