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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
Pressure Ulcer
1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
 123
Assessment - Ulcer Characteristics
Prevention - Risk Assessment Tool (Braden, Norton)
Pressure Ulcer Staging

1) Limited or no experience
2) Experienced, but may need review or supervision
3) Able to function independently *
 123
Reactive Hyperemia
Stage One
Stage Two
Stage Three
Stage Four
Deep Tissue Injury
Pressure Ulcer Support Surfaces

1) Limited or no experience

2) Experienced, but may need review or supervision
3) Able to function independently *
 123
Static Air
Alternating Air
Foam
Gel
Water
Combination
Low Airloss
Dynamic (Kinetic) Air
Air Fluidized
Continuous Lateral Rotation
Neuropathic (Diabetic Foot) Ulcer Treatment

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Offloading
Serial Debridement
Prevention/Diabetic Teaching
Ulcer Assessment Characteristics
Venous Stasis Ulcer Treatment

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Compression Therapy
Ulcer Assessment Characteristics
Skin Signs of Venous Stasis
Peripheral Arterial Ulcer (PAD)

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Ankle Brachial Index
Ulcer Assessment Characteristics
Skin Signs of Diminished Circulation
Other Wounds

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Fistulae - Pouching, Skin Care
Drains - Management of
G/J Tubes - Anchoring, Skin Care
Wound Care Treatment

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Debridement
Autolytic
Enzymatic
Mechanical
Sharp
Surgical
Dressings/Treatments
Hydrogels
Hydrocolloids
Silver Products
Foams
Alginates
VAC (Vacuum Assisted Closure)
Growth Factors
Skin Substitutes
Hyperbaric Oxygen Therapy
Culturing of Wounds
Electrical Stimulation
Enzymatic Debriding Agents
Debriding Ointments
Mist Therapy
Colostomy

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Loop w/Rod Stoma
End Stoma
Mucous Fistula
Double Barrel Stoma
Irrigation Procedure
Stoma Within Incision
Related Conditions/Surgeries
Abdominoperineal Resection
Rectal Cancer/Colon Cancer
Diverticulitis
Colitis/Crohn’s Disease
Pelvic Exenteration Anterior
Pelvic Exenteration Posterior
Ileostomy

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Loop w/Rod Stoma
End Stoma
Ileal Lavage
Related Conditions
Crohn’s Disease
Ulcerative Colitis
Familial Polyposis
Short Bowel Syndrome
Continent Ileostomy

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Kock Pouch
Pelvic Pouch
Continent Urostomy

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Kock Pouch
Indiana Pouch
Neobladder
Stomal, Peristomal Skin Conditions

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Flush or Recessed Stoma
Stomal Necrosis
Stomal Prolapse
Peristomal Hernia
Denuded Skin/Ulcerations
Skin Infections/Fungal Infections
Mucocutaneous Separation
Hyperplasia
Pyoderma Gangrenosum
Stoma Plane Dynamics
Ostomy Equipment

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
One-Piece/Two-Piece Appliance
Open End, Closed End, Clip or Velcro Closure for Pouches
Convex/Flexible Pouching Systems
Skin Barriers/Sealants
Barrier Pastes/Strips/Rings/Discs/Washers
Wound Pouches
Molding Kit for Custom Appliances
Irrigation Procedure
Single/Double Lumen Catheters for Culture
Reusable Ostomy Equipment
Measure for Ostomy Belts/Peristomal Hernia Support Belt
Continence Evaluation/Assessment

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Urodynamics
Manometry
Electromyography
Leak Point Pressures
Cystometrogram
Uroflometry
Biofeedback - Diagnostic/Treatment
PNTML (Pudendal Nerve Terminal Motor Latency)
Ultrasound
Continence Skin Care/Containment

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Skin Sealants
Moisture Barriers
Absorbent Garments
Skin Care
Continence Therapeutic Devices

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Vaginal Cones
Penile Clamps
Male Urinals
Male External Catheters
Internal Urethral Inserts (Female)
Catheters - Indwelling
Catheters - Intermittent Self Cath and Teaching for
Magnetic Therapy
Urinary Incontinence/Bladder Programs
Fecal Incontinence/Bowel Programs
Pediatric Related Conditions

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Necrotizing Enterocolitis
Inflammatory Bowel Disease
Irritable Bowel Syndrome
Meckel Diverticulum
Familial Adenomatous Polyposis
Distal Ureter or Bladder Defects
Hirschsprung’s Disease
Megacolon
Malabsorption Syndromes
Obstructive Disorders
Spinal Cord Injury
Neurogenic Bladder
Diaper Dermatitis
Stoma Care - Loop Stoma
Dehydration Risks in Pediatric Patients
High Output Stoma - Skin Barrier Issues
G/J Tubes

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Anchoring Devices
Skin Protection for Leakage of Gastric Contents
Long Term Tubes/Skin Level Devices for Feeding
Procedures for Flushing/Treatment for Clogging
Other

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
IV Infiltration Wounds
Incision Care
Burns
Bariatric Patients
Self-Catheterization/Teaching
Indwelling Catheter Care
Medications
Bowel and Bladder Training Programs
Interpretation of Lab Results

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
Albumin/Total Protein
Obtaining Wound Cultures
Urine Cultures
Tumor Staging
Pathology Reports
Ostomy Equipment

(1) Limited or no experience
(2) Experienced, but may need review or supervision
(3) Able to function independently *
 123
One-Pi
Age Specific Competencies Experience

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