Competency Checklist, Pediatrics by tcoady


First Name: _______________                   Last Name: ________________                Date: ______________________

Age – Specific Practice
Please list your TOTAL years experience in caring for the following age groups:

A. Newborn (Up to 30 days)                  D. Preschooler (4-5 yrs.)                    G. Young Adults (18-39 yrs.)
B. Infant (30 days to 1 yr.)                E. School Age (5-12 yrs.)                    H. Middle Aged Adults (39-64 yrs.)
C. Toddler (1-3 yrs.)                       F. Adolescents (12-18 yrs.)                  I. Older Adults (64 yrs. And older)

Please indicate your experience with the above-listed age groups: (Check the appropriate boxes)

                                                                                            A   B    C    D       E   F   G    H   I
Able to adapt care to incorporate normal growth and development
Able to adapt method and terminology of patient instructions to their age,
comprehension and maturity level
Can ensure a safe environment reflecting specific needs of various age groups

Please indicate your level of experience in the following areas. Rank each skill using the following
numbers to indicate your level of proficiency:

1. Clinical Observation or didactic learning: No experience

2. Limited or infrequent experience

3. Experienced. May occasionally need resource assistance

4. Proficient: Can perform/teach without assistance

                  GENERAL SKILLS                              EXP.                        GENERAL SKILLS                       EXP.
Abdominal assessment                                                    Normal growth and development
Blood glucose monitoring                                                Normal laboratory values
Breath sounds                                                           Nutritional assessment
BUN & creatinine lab value assessment                                   Nutritional status
Death/Dying                                                             Pain level/tolerance assessment
Family intervention skills                                              Rate/work of breathing
Fever management                                                        Recognition of signs of abuse/neglect
Fluid balance assessment                                                Serum electrolytes lab value assessment
Growth/developmental parameters                                         Skin breakdown assessment
Interpretation of blood chemistry                                       Stasis ulcers
Interpretation of blood counts                                          Surgical wound healing
Isolation                                                               Thyroid studies interpretation

                                         developed by Beth Nash, RN from
Level of consciousness assessment                              Urinalysis lab value assessment
                  CARDIAC SKILLS                       EXP.                       CARDIAC SKILLS                   EXP.
Auscultation (rate, rhythm, volume)                            EKG interpretation
Blood pressure/non-invasive                                    Heart sounds/murmurs
Central venous pressure                                        Perfusion
Defibrillation/cardioversion                                   Pulses

                SKILLS/PROCEDURES                      EXP.                     SKILLS/PROCEDURES                  EXP.
1st degree burns (throughout body)                             ICP monitoring
2nd degree burns                                               Ingestion of foreign body
3rd degree burns                                               Ingestion of poison/toxins
Airway management devices/suctioning                           I-Tubes
Anorexia/bulimia                                               Jejunal feeding
Apnea monitor                                                  NG & Sump tubes to suction
Application of splints                                         Oximeter
                                                               Oxygen therapy delivery systems: face mask, hood,
Assist with lumbar puncture
                                                               incubator, nasal cannula, tent, trach collar
Assist with suprapubic tap                                     Penrose drains
Blood glucose testing                                          Pinned fractures
Cast                                                           Placement of naso/orogastric tube
Catheter care                                                  Plastic surgery
Catheter insertion                                             Pressure sores – prevention/treatment
Chest physiotherapy                                            Staged decubitus ulcers
Chest tubes                                                    Sterile dressing changes
Collection of urine specimen                                   Suicidal threats/actions
Craniofacial reconstruction                                    Surgical wounds with drain(s)
Depression                                                     Traction
End Tidal CO2                                                  Traumatic wound care
ENT surgery                                                    Use of air fluidized, low airloss beds
Eye surgery                                                    Water Seal drainage system
Feedings: bottle, breast, gavage, central or
                                                               Wound care/irrigations
peripheral hyperalimentation
Gastrostomy/Button                                             Wound irrigation/dressing Change

              CARE OF THE CHILD WITH:                  EXP.                 CARE OF THE CHILD WITH:                EXP.
Adrenal disorders                                              Infantile polycystic disease
AIDS                                                           Infectious Mononucleosis
Anal fissure                                                   Intestinal parasites
Anemia                                                         IV conscious sedation
Asthma                                                         Juvenile diabetes
Bacterial Endocarditis                                         Kawasaki disease
Battered Child Syndrome                                        Kidney transplant
Bone marrow transplant                                         Leukemia
Bronchiolitis (RSV)                                            LTB/Croup
Bronchopulmonary Dysplasia (BPD)                               Lyme disease
Cardiac arrest                                                 Malignant tumors
Cardiomyopathy                                                 Meningitis
Circumcision                                                   Multiple sclerosis
Cleft lip/palate                                               Multiple trauma
Closed head trauma                                             Myocarditis
Clubfoot                                                       Narcotic analgesia
Colostomy                                                      Near-drowning

                                      developed by Beth Nash, RN from
Common Childhood - communicable diseases                     Necrotizing Enterocolitis (NEC)
Congenital heart disease/defects                             Nephrotic syndrome
Congestive heart failure                                     Neuromuscular Disease
Cushing's Syndrome                                           Osteogenic Sarcoma
Cystic Fibrosis                                              Osteomyelitis
Cytomegalo Virus (CMV)                                       Pericarditis
Depressed Immune System                                      Peritoneal Dialysis
Diaphragmatic Hernia                                         Pertussis
Disseminated Intravascular Coagulation (DIC)                 Pituitary Disorders
Encephalitis                                                 Pneumonia
Epidural anesthesia/analgesia                                Post Cardiac Catheterization
Epiglottitis                                                 Post Cardiac Surgery
Failure to thrive (FTT)                                      Pyloric Stenosis
Febrile seizures                                             Renal failure
Gastroenteritis/dehydration                                  Rheumatic Fever
GE reflux                                                    Sickle Cell Anemia
GI bleeding                                                  Spinal cord injury
Glomerulonephritis                                           Spleen Trauma/Splenectomy
Hemodialysis                                                 Surgical Abdomen
Hemolytic Uremic Syndrome (HUS)                              Thyroid malfunction
Hemophilia                                                   Tonsillitis
Hepatitis                                                    Tuberculosis
Hodgkin's Disease                                            Ulcerative Colitis
Hypospadias                                                  Urinary tract infection
Ileal Conduit, Ureteral                                      Wilms’ Tumor

Administer blood/blood products: plasma,
cryoprecipitate, PRBC’s, whole blood                         Hyperalimentation
Administer continuous infusions                              Infusion pumps
Administer IV antibiotics/piggybacks                         IV Rate calculations
Administer IV push                                           Peripheral Line
Central line/catheter/dressing: Broviac, Groshong,
Hickman, Portacath, Quinton,                                 Starting IV's
Change IV dressings                                          Removal of central lines
Drawing venous blood

Alupent (Meraproteranol)                                     Isuprel (Isoproterenol)
Aminophylline (Theophylline)                                 Knowledge of Emergency Drugs
Calculation of Pediatric Doses                               Knowledge of Routine Pediatric Drugs
Chemotherapy Certification (Yes or No)                       Metered Dose Inhaler
Clonopin (Clonazepam)                                        Phenobarbital
Corticosteroids                                              Prednisone
Dilantin (Phenytoin)                                         Tegretol (Carbamazepine)
Dioxin (Lanoxin)                                             Thyroid
Eye/Ear Installations                                        Valium (Diazepam)
Growth Hormone                                               Ventolin (Albuterol)

                                    developed by Beth Nash, RN from

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