Skills Checklist - Dietitian

This Skills Checklist is a self-evaluation to assess your recent experience in various clinical settings focusing on the past 2 years.

0 = No Experience
1 = Some Experience
2 = Intermittent Experience
3 = Experienced
4 = Very Experienced

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AGE OF PATIENTS CARED FOR

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Newborn/Neonate (birth to 30 days)
Infant (1 month to 1 year)
Toddler (1 year to 3 years)
Preschooler (3 years to 5 years)
School Age Child (5 years to 12 years)
Adolescents (12 years to 18 years)
Young Adults (18 years to 39 years)
Middle Adults (39 years to 64 years)
Older Adult (64 years to 79 years)
Elderly Adult (over 70+ years)

GENERAL SKILLS

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Standard Precautions
Isolation Precautions
Pediatric Respiratory/Cardiac Arrest
Adult Respiratory/Cardiac Arrest
Crash Carts
Defibrillators
Patient and Family Education
Electronic Documentation
Managing Food-Drug Interactions
Managing Food-Drug Timing
Managing Nutrition Therapy Complications

ASSESSMENT/PATIENT CARE

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Develop Plan of Treatment
Document Refusal of Care
Document Non-Compliance
Determine Usual or Adjusted Body Weight
Determine Energy Requirements
Determine Protein Requirements
Determine Fluid Requirements
Determine Electrolyte Requirements
Determine Fat Requirements
Determine Micronutrient Requirements
Perform Nutrition Education
Perform Nutrition Assessments

NUTRITION STATUS

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Clinic Malnutrition
Poor Diet
Eating Difficulties
Marginal Malnutrition
Metabolic Demands
Nutrient Deficiencies
Assess Fluid Status
Kwashiorkor
Marasmus
Cachexia
Protein Calorie Malnutrition

CONDITIONS/DISEASES AFFECTING NUTRITION

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Abdominal Wounds and Surgeries
Abnormal Bleeding
Acute MI
Acute Renal Failure
Alzheimer's Disease
Anorexia Nervosa
Aspiration
Bulimia
Cancer
Chronic Diarrhea
Coma
Congenital Heart Defects
Congestive Heart Failure
COPD
CVA
Decubitus
Diabetes
Diabetic Ketoacidosis
Draining Abscesses
Draining Wounds
Drug Overdose
Dysphagia
Elevated Cholesterol/Triglycerides
End Stage Renal Disease
Epiglottitis
Excessive Alcohol Intake
Extensive Burns
Failure to Thrive
Fever
Fistulae
Hemodialysis
Hepatitis
HIV/AIDS
Homelessness/Limited Access to Food
Hyperemesis
Infection
Inflammatory Bowel Disease
Liver Failure
Low Blood Sugar
Major Surgery
Malabsorption Syndromes
Mucositis
Pancreatitis
Peritoneal Dialysis
Pregnancy
Protracted Emesis
Radiation
RDS
Refeeding Syndrome
Renal Transplants
Sepsis
Short Gut Syndrome
Sickle Cell Anemia
Status Asthmaticus
Stomatitis
Transplants
Trauma
Tuberculosis
Vented Patient
Wounds
Morbid Obesity
Post-Op Gastric Stapling/Gastric Bypass
Depression

MEDICATION AFFECTING NUTRITION

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Steroids
Immunosuppressants
Antineoplastics
Insulin
Diuretics
Blood Thinners
Laxatives

LAB MONITORING

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LFT's
Serum Ammonia
Serum Amylase
Cholesterol
BUN
Serum Electrolytes
Blood Glucose
Hematology
Creatinine
Albumin
Pre-Albumin
C-Reactive Proteins
Nitrogen Balance
Acid/Base Balance
Protein-Energy Balance
Vitamins and Minerals

MANAGING NUTRITION THERAPY

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Oral Diets
Enteral Nutrition
Parenteral Nutrition
Writing Orders for Nutrition
Intake and Output
Fluid Balanace
Calorie Counts
Small Bowel Feeding Tubes
Gastrostomy Tubes
Jejunostomy Tubes

SETTINGS

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Hospital
Clinic
Long Term Care
Retirement Center
Hospice
Home Health
Research
Daycare
Correctional Facility
Restaurant
Public Health
Community Programs

Position Category

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Total Years of Experience

First Name

Last Name

Social Security #

Date of Birth

Email

Phone

Attestation

I certify that the information provided above accurately reflects education received and my experience in each of the clinical areas identified, particularly within the last 2 years. I hereby authorize Alliant Personnel Resources (The Company) to collect, store, and release any information that I have provided in this Skills Checklist and/or any other documentation and information they have collected or that I have submitted in any form to its parent company(s), its subsidiaries, or other subcontractors/its service providers as it deems necessary in its business operations as well as to individuals and companies in relation to consideration of employment as a Healthcare Professional with those companies and individuals. I acknowledge that The Company will take precaution and care to protect my personal information that is collected/stored/shared but cannot guarantee permanent data security and I release The Company from all related liability for damages or punitive liability.

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