RESPIRATORY THERAPY KNOWLEDGE &

SKILLS CHECKLIST_____
NAME:       (4) Radial artery/Allen tests
ID #:      
DATE:       DIRECTIONS: Please indicate your level of
experience by placing a check (√) in the
box. Experience level:
This Skills Checklist is for use by nurses 1 NO EXPERIENCE
with more than one year experience in 2 MINIMAL EXPERIENCE-requires
their discipline and specialty. Please be supervision/assistance
accurate with your assessment. 3 MODERATELY EXPERIENCED-requires
initial review, then performs
independently
DESCRIPTION 1 2 3 4 4 VERY EXPERIENCED- proficient
TREATMENTS / PROCEDURES
1. Assessment
a. Breath sounds DESCRIPTION 1 2 3 4
b. Peak flow rate g. Extubate
c. Pulmonary function testing h. Extubation assistance
d. Rate and work of breathing i. Hemodynamic monitoring
e. Transcutaneous monitoring j. Incentive spirometry
2. Interpretation of Lab Results k. Infection control practices
a. Arterial blood gases l. Intubate
b. Basic EKG m. Intubation assistance
c. Blood chemistry n. Medication delivery systems
d. Chest x-ray (1) Aerosol heated/cool
3. Equipment & Procedures (2) Aerosol set up-mask
a. Airway management devices/suctioning (3) Aerosol set up-trach
(1) Check intracuff pressure (4) IPPB
(2) Endotracheal (5) Medihaler
tube/suctioning (6) Metered dose inhalers
(3) Nasal airway placement o. O2
(4) Nasal airway/suctioning (1) Bag and mask
(5) Oral airway placement (2) ET tube
(6) Oropharyngeal/suctioning (3) External CPAP
(7) Sputum specimen (4) Face masks
collection (5) Nasal cannula
(8) Tracheostomy/suctioning (6) Nebulizer
b. Analyze oxygen (a) Cold
c. Arterial line insertion (b) Hand held
d. Care of the patient with a chest tube (c) Heated
(1) Assessment of (d) Ultrasonic
function/proper operation (7) O2
(2) Placement assistance (8) T-piece
e. Chest physiotherapy (9) Trach collar
f. Drawing arterial blood gases p. Thoracentesis assistance
(1) Arterial line q. Ventilator set up and care
(2) Brachial artery (1) Assist/control
(3) Femoral artery (2) CPAP
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 RESPIRATORY THERAPY KNOWLEDGE &
SKILLS CHECKLIST_____
(3) Flow-by 3. Able to communicate and instruct
(4) High frequency jet patient according to their age, maturity
ventilator and comprehension ability.
Name:       A B C D E F G H I
ID #:      
4. Able to provide a safe environment
DESCRIPTION 1 2 3 4
according to the specific needs of various
3. EQUPMENT & PROCEDURES (CONT)
age groups.
q. Ventilator set up and care (cont)
A B C D E F G H I
(5) High frequency oscillator
(6) IMV
(7) Inverse ratio ventilator
MY EXPERIENCE IS PRIMARILY IN:
(8) Pressure support
NEUROLOGY       years
(9) Pressure vents
PULMONARY       years
COMPUTERIZED CHARTING
SURGICAL       years
1. Cerner
MEDICAL       years
2. Eclipsys
CARDIAC CARE       years
3. Epic
TELEMETRY       years
4. McKesson
5. Meditech
I HAVE CURRENT CERTIFICATIONS FOR:
6. Other: TYPE EXPIRATION
DATE (MM/DD/YY)
Please check the boxes below for each ARRHYTHMIA      
age group for which you have expertise in
CRITICAL CARE      
providing age-appropriate nursing care.
ACLS      
A. Newborn/Neonatal (birth – 30 days)
BLS      
B. Infant (30 days – 1 year)
TNCC      
C. Toddler (1 – 3 years)
NRP      
D. Preschool (3 – 5 years)
PALS      
E. School Age Children (5 – 12 years)
NALS      
F. Adolescent (12 – 18 years)
Other            
G. Young Adults (18 – 39 years)
Other            
H. Middle Adults (40 – 64 years)
Other            
I. Older Adults (64 + years)
Other            
EXPERIENCE WITH AGE GROUPS:
1. Able to assess age appropriate
The information I have provided in this
behavior, motor skills and physiological
knowledge and skills checklist it true and
norms.
accurate to the best of my knowledge.
A B C D E F G H I
           
Signature Date
(Written/Electronic)
2. Able to adapt care according to normal ID #:      
growth and development.
A B C D E F G H I This skills checklist has been reviewed
and approved by Nicole Bloxham, RN.
           
Signature Date
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 RESPIRATORY THERAPY KNOWLEDGE &
SKILLS CHECKLIST_____
(Written/Electronic)
ID #:      

Please return to: Northwest Nurse Staffing

Company, PA
ATTN: Records Dept.
Fax: (866) 352-4338

Email: records@nns-ic.com

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