LPN Self Assessment
Name
First Name
Last Name
Email
example@example.com
Date
-
Month
-
Day
Year
Date
RESPIRATORY
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not
Applicable
Assessment of Breath Sounds
Administer O2 (NC, Mask)
Assist with Intubation
Ventilate with Ambu-bag
Suctioning
Assist with Extubation
Use of Pressure Ventilators
Use of Volume Ventilators
Weaning Patient from Ventilator
Use of CPAP
Use of PEEP
Use of Assist-Control
Troubleshoot Ventilator Problems
Pulse Oximetry
Perform Arterial Puncture
Draw Blood from Arterial Line
Interpret Arterial Blood Gases
Assist with Chest Tube Insertion
Assist with Thoracentesis
Assist with Bronchoscopy
Assist with Cricothyroid Airway
Isolation Techniques
Postmortem Care
Pre-operative Care/Preparation
Post-anesthesia Care
NEUROLOGICAL
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not
Applicable
Neuro Assessment/ Vital Signs
Glasgow Coma Scale
Assist with Lumbar Puncture
Intracranial Pressure Monitoring
Seizure Precautions
Aneurysm Precautions
Use of Rotating Bed
Use of Stryker Frame
Epidural Medication Admin
Arterial Lines
Central Venous Catheter
Pulmonary Artery Catheter
Pericardiocentesis
Placement of External Pacemaker
Intra-aortic Balloon (IABP)
Chest Injury
Hemo/Pneumo
Tracheostomy
ECMO
ARDS
Pulmonary Edema
Lung Transplant
Assess Respiratory Complications
EMERGENCY MEDICATION ADMINISTRATION
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not
Applicable
Epinephrine
Atropine
Lidocaine
Bretylium
Bicarbonate
TPA
Vaso-active Drips:
Dopamine
Nipride
Nitroglycerin
Inocor
Dobutamine
RENAL
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not
Applicable
Acute Renal Failure
Chronic Renal Failure
Hemodialysis
Peritoneal Dialysis
Renal Transplant
AV Fistula
GASTROINTESTINAL
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not
Applicable
Assessment of Bowel Sounds
Identification of Abnormalities
Insert / Maintain Feeding Tubes
Insert/Maintain NG tubes
GI Bleed
Esophageal Hemorrhage
Acute Pancreatitis
Open Abd Wound/Incision
Peritoneal Lavage
Abdominal Aortic Aneurysm
MEDICATION ADMINISTRATION
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not
Applicable
Moderate/Conscious Sedation
Sedation Reversal Agents
Antibiotics IM/IV
Antiemetics
Adenosine
Aminophylline(Theophylline)
Atropine
Anticoagulants
Anticonvulsants
Antihypertensives
Barbituate Induced Coma
Charcoal
Cardizem
Cordarone
Decadron
Dopamine
Diuretics
Epinephrine
Heparin Drip protocol
Inotropes (Digoxin,Dobutamine,Primacor)
Inocor
Insulin Infusions
Intrathecal Medication
Isuprel
Kayexelate
Lidocaine
Mannitol
Nitroglycerin
Nipride
Steroids
Thrombolytic Therapy
Vasopressin
Ventolin (Albuterol)
CARDIOVASCULAR
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not
Applicable
Assessment of Heart Sounds
Use of Cardiac Monitors
Identify Lethal Dysrhythmias
Telemetry
Perform 12-lead EKG
Basic 12-Lead Interpretation
Assist with Code
Defibrillation/Cardioversion
Cardiac Arrest / CPR
Assist with Open Chest Procedure
Continuous Cardiac Monitoring
Myocardial Contusion
Acute MI
Congestive Heart Failure
Pre/post Cardiac Cath
Pre/post Cardiac Surgery
Cardiac Tamponade
Aneurysm
Permanent Pacemaker
Temporary Pacemaker
Intra-aortic Balloon Pump (IABP)
Automatic Implanted Defibrillator
Heart Transplant
Cardiogenic Shock
Septic Shock
Hypovolemic Shock
DIC
Ventricular Assist Device
Vascular Surgeries
Fresh Open Heart Surgery
Open Heart Surgery ( more than 6 hrs. post-op)
EP Study and Ablation
Central Venous Pressure
Arterial Pressure (MAP)
PA Pressure
PCW Pressure
Cardiac Output (thermodilution)
SVO2
Intervene PA Catheter Problems
Obtain ABG
Obtain Mixed Venous Gases
OTHER PATIENT CARE
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not
Applicable
Multiple Trauma
Burns
Oncology
Chemotherapy
AIDS
Ketoacidosis
Bone Marrow Transplant
Liver Transplant
Open/Closed Head Injury
Acute CVA
Spinal Cord Injury
Craniotomy
Increased ICP
Cerebral Aneurysm
Halo Traction/Cervical Tongs
Degenerative Diseases of CNS
CNS Infections
Drug Overdose / DTs
AGE OF PATIENTS CARED FOR
*
No Experience
Requires education, training and supervision
Intermittent Experience
May require support or supervision
Proficient
Consistent experience, independent
Expert Level; Can teach and/or supervise others
Not
Applicable
Newborn (birth-30 days)
Infant (30 days - 1 year)
Toddler (1 - 3 years)
Preschooler (3 - 5 years)
School Age (5 - 12 years)
Adolescents (12 - 18 years)
Young Adults (18 - 39 years)
Middle Adults (39 - 64 years)
Older Adults (64+ years)
Please list any additional skills not listed above
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