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RENAL/GENITOURINARY EXPERIENCE

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
Assessment Of Renal/Gu System123
Insertion Of Foley123
CARE OF PATIENT WITH:

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
Nephrostomy Tube123
Av Fistula / Av Graft123
Tunneled / Non - Tunneled Catheter123
Ileal Conduit123
Supra - Pubic Catheter123
Chronic Renal Failure123
Acute Renal Failure123
Nephrectomy123
Turp123
Peritoneal Dialysis123
Hemodialysis123
Fluid Overload123
Hypo / Hypertension123
Disequilibrium Syndrome123
Hypo / Hyperkalemia123
Seizures123
Clotted Access / Poor Blood Flow123
Pyrogenic Reaction123
Hemolysis123
Air Embolus123
Chest Pain123
Anemia123
Neuropathy123
Pericarditis123
Filter Blood Leak123
Cardiac Arrest123
HEMODIALYSIS / PROCEDURES

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
Acute / Inpatient Dialysis123
Chronic / Outpatient Dialysis123
Dialysis Home Care123
Pediatric Dialysis123
Predialysis Nursing Assessment123
Teaching The Dialysis Patient And Family123
SET-UP / STARTING DIALYSIS TREATMENT

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
Collect Blood Specimens123
Anticoagulation123
Dialysis123
Fistula Gortex / Bovine Graft123
Prep Vascular Access123
Checking Alarm Settings / Machine123
Priming Dialyzer123
Conductivity Testing123
Bicarbonate Dialysis123
ASSESS PATIENT & EQUIPMENT DURING DIALYSIS

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
Systems Assessment Of Patient123
Volume Status123
Vascular Access Function123
Arterial And Venous Pressures123
Blood Flow Rate123
Subjective Response To Treatment123
Management Of Anticoagulation123
Conductivity123
Ultrafiltration Calculation123
Operation Of Myron L Meter123
Administration Of Blood/Blood Products123
Administration Of Mannitol123
Sequential Ultrafiltration / Puf123
Documentation Of Treatment123
DISCONTINUED DIALYSIS

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
Dialysis Catheter123
Fistula / Vein Graft123
Return Of Blood123
Post Treatment Access Care123
Equipment Clean Up123
Sterilization Procedures123
MISCELLANEOUS

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
Care Of Immuno- suppressed Patient123
Care Of Patient With Aids123
Isolation Techniques123
Assessment Of Wound Healing123
Sterile Dressing Changes123
Phlebotomy / Venous Blood Draw123
Patient Education regarding Organ & Tissue Donation123
AGE-SPECIFIC CHECKLIST

Rank each of the following sections on a scale of 1 to 3:
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
Newborn / neonate (birth-30 days)123
Infant (31 days-1 year)123
Toddler (ages 2-3 years)123
Preschool (ages 4-5 years)123
School age (ages 6-12 years)123
Adolescent (ages 13-21 years)123
Young adult (ages 22-39 years)123
Adult (ages 40-64 years)123
Older adult (ages 65-79 years)123
Elderly (ages 80+ years)123
ATTESTATION *