PREMIER                                                                                                  Cornice Inc.
                    HEALTHCARE                                                                         191 University Blvd #252 Denver, CO 80206
                    STAFFING                                                                           Phone: (866) 267-6633 Fax: (866) 267-6693

                                      PEDIATRIC NURSING SKILLS CHECKLIST
                                     1) Intermittent experience 2) 1-2 year experience 3) 2 years plus experience
PROCEDURE                                               1     2      3       PROCEDURE                                                 1       2        3
                                                                  A. CARDIOVASCULAR
1. Assessment                                                                a. Bacterial endocarditis
a. Auscultation (rate, rhythm, volume)                                       b. Cardiac arrest
b. Blood pressure/non-invasive                                               c. Cardiomyopathy
c. Heart sounds/murmurs                                                      d. Congenital heart defects/disease
d. Perfusion                                                                 e. Congestive heart failure
2. Interpretation of lab results                                             f. Myocarditis
a. Arterial blood gases                                                      g. Pericarditis
b. Hemoglobin & hematocrit                                                   h. Post cardiac cath
3. Equipment & procedures                                                    i. Post cardiac surgery
a. Basic EKG interpretation                                                  j. Rheumatic fever
b. Non-invasive cardiac monitoring                                           k. Shock
4. Care of the child with:                                                   5. Medication - Digoxin (Lanoxin)
                                                                     B. PULMONARY
1. Assessment                                                                (5) Tent
a. Breath sounds                                                             (6) Trach collar
b. Rate and work of breathing                                                h. Water seal drainage system
2. Equipment & procedures                                                    3. Care of the child with:
a. Airway management devices/suctioning                                      a. Asthma
(1) Bulb syringe                                                             b. Bronchiolitis (RSV)
(2) Nasal airway/suctioning                                                  c. Bronchopulmonary dysplasia (BPD)
(3) Oral airway/suctioning                                                   d. Cystic fibrosis
(4) Tracheostomy/suctioning                                                  e. Epiglottitis
b. Apnea monitor                                                             f. LTB/croup
c. Chest physiotherapy                                                       g. Pertussis
d. Chest tubes                                                               h. Pneumonia
e. End tidal CO2                                                             i. Tonsillitis
f. Oximeter                                                                  j. Tuberculosis
g. Oxygen therapy delivery systems                                           4. Medications
(1) Face mask                                                                a. Alupent (Meraproteranol)
(2) Hood                                                                     b. Aminophylline (Theophylline)
(3) Isolette                                                                 c. Isuprel (Isoproterenol)
(4) Nasal cannula                                                            d. Ventolin (Albuterol)
                                                            C. NEUROLOGICAL / ORTHOPEDICS
1. Assessment - level of consciousness                                       g. Multiple sclerosis
2. Equipment & procedures                                                    h. Multiple trauma
a. Application of splints                                                    i. Near drowning
b. Assist with lumbar puncture                                               j. Neuromuscular disease
c. Cast                                                                      k. Osteogenic sarcoma
d. ICP monitoring                                                            l. Osteomyelitis
e. Pinned fractures                                                          m. Spinal cord injury
f. Traction                                                                  4. Medications
3. Care of the child with:                                                   a. Clonazepam (Klonopin)
a. Battered child syndrome                                                   b. Corticosteroids
b. Closed head trauma                                                        c. Dilantin (Phenytoin)
c. Clubfoot                                                                  d. Phenobarbital
d. Encephalitis                                                              e. Tegretol (Carbamazepine)
e. Febrile seizures                                                          f. Valium (Diazepam)
f. Meningitis
                                                                  D. GASTROINTESTINAL
1. Assessment                                                                (1) Bottle
a. Abdominal                                                                 (2) Breast
b. Nutritional                                                               (3) Central hyperalimentation
2. Interpretation of lab results - Serum electrolytes                        (4) Gavage
3. Equipment & procedures                                                    (5) Peripheral hyperalimentation
a. Feedings                                                                  b. Gastrostomy/button
PROCEDURE                                          1      2    3    PROCEDURE                                1   2       3
c. I-tubes                                                           d. Diaphragmatic hernia
d. Jejunal feeding                                                   e. Failure to thrive (FTT)
e. NG and sump tubes to suction                                      g. GE reflux
f. Penrose drains                                                    h. GI bleeding
g. Placement of naso/orogastric tube                                 i. Ileostomy
h. Wound irrigation/dressing change                                  j. Intestinal parasites
4. Care of the child with:                                           k. Necrotizing enterocolitis (NEC)
a. Anal fissure                                                      l. Pyloric stenosis
b. Cleft lip/palate                                                  m. Surgical abdomen
c. Colostomy                                                         n. Ulcerative colitis
                                                       E. RENAL/GENITOURINARY
1. Assessment - fluid balance                                        a. Circumcision
2. Interpretation of lab results                                     b. Glomerularnephritis
a. BUN & creatinine                                                  c. Hemodialysis
b. Urinalysis                                                        d. Hemolytic uremic syndrome (HUS)
3. Equipment & procedures                                            e. Hypospadias
a. Assist with suprapubic tap                                        f. Ileal conduit ureteral
b. Catheter insertion                                                g. Infantile polycystic disease
(1) Catheter care                                                    h. Kidney transplant
(2) Female                                                           i. Nephrotic syndrome
(3) Indwelling                                                       j. Peritoneal dialysis
(4) Male                                                             k. Renal failure
(5) Straight                                                         l. Urinary tract infection
c. Collection of urine specimen                                      m. Wilm's tumor
4. Care of the child with:
                                                       F. ENDOCRINE/METABOLIC
1. Assessment                                                        b. Cushing's syndrome
2. Interpretation of lab results                                     c. Juvenile diabetes
a. Blood glucose                                                     d. Pituitary disorders
b. Thyroid studies                                                   e. Thyroid malfunction
3. Equipment & procedures                                            5. Medications
a. Blood glucose testing: type: _____________                        a. Growth hormone
4. Care of the child with:                                           b. Insulin
a. Adrenal disorders                                                 c. Thyroid
                                                       G. HEMATOLOGY/ONCOLOGY
1. Assessment of nutritional status                                e. Hemophilia
2. Interpretation of lab results                                   f. Hodgkin's disease
a. Blood chemistry                                                 g. Infectious mononucleosis
b. Blood counts                                                    h. Leukemia
3. Equipment & procedures - reverse isolation                      i. Malignant tumors
4. Care of the child with:                                         j. Sickle cell anemia
a. Anemia                                                          k. Spleen trauma/splenectomy
b. Bone marrow transplant                                          5. Medications
c. Depressed immune system                                         a. Chemotherapy certification?
d. Disseminated intravascular coagulation (DIC)                    b. Prednisone
                                              H. MEDICATION ADMINISTRATION FOR CHILDREN
1. Calculation of pediatric doses                                  4. Knowledge of routine pediatric drugs
2. Eye/ear installations                                           5. Metered dose inhaler
3. Knowledge of emergency drugs
                                                       I. PHLEBOTOMY/IV THERAPY
1. Equipment & procedures                                            (3) Heparin lock
a. Administration of blood/blood products                            2. Care of the child with:
(1) Cryoprecipitate                                                  a. Central line/catheter/dressing
(2) Packed red blood cells                                           (1) Broviac
(3) Whole blood                                                      (2) Groshong
b. Drawing blood from central line                                   (3) Hickman
c. Drawing venous blood                                              (4) Portacath
d. Starting IVs                                                      (5) Quinton
(1) Angiocath                                                        b. Cutdown line/dressing
(2) Butterfly                                                        c. Peripheral line/dressing

PROCEDURE                                             1      2     3      PROCEDURE                                               1           2           3
                                                           J. INFECTIOUS DISEASES
1. Interpretation of lab results - blood count                         b. Common childhood - communicable diseases
2. Equipment & procedures                                              c. Cytomegalovirus virus (CMV)
a. Fever management                                                   d. Hepatitis
b. Isolation                                                          e. Kawasaki disease
3. Care of the child with:                                            f. Lyme disease
                                                              K. MISCELLANEOUS
1. Assessment                                                             c. Depression
a. Normal growth and development                                          d. ENT surgery
b. Normal laboratory values                                               e. Eye surgery
c. Recognize signs of abuse or neglect                                    f. Ingestion of foreign body
2. Medication - immunization schedule                                     g. Ingestion of poison or toxins
3. Care of the child with:                                                h. Plastic surgery
a. Anorexia/bulimia                                                       i. Suicidal threats/actions
b. Craniofacial reconstruction
                                                           L. WOUND MANAGEMENT
1. Assessment                                                             d. Pressure sores
a. Skin for impending breakdown                                           e. Staged decubitus ulcers
b. Stasis ulcers                                                          f. Sterile dressing changes
c. Surgical wound healing                                                 g. Surgical wounds with drain(s)
2. Equipment & procedures                                                 h. Traumatic wound care
a. 1st degree burns (throughout body)                                     i. Use of air fluidized, low airloss beds
b. 2nd degree burns                                                       j. Wound care/irrigations
c. 3rd degree burns
                                                             L. PAIN MANAGEMENT
1. Assessment of pain level/tolerance                                     b. IV conscious sedation
2. Care of the child with:                                                c. Narcotic analgesia
a. Epidural anesthesia/analgesia

                                                    AGE SPECIFIC PRACTICE CRITERIA
Please check the boxes below for each age group for which you have expertise in providing age appropriate nursing care.
A. Newborn/Neonate (birth – 30 days)                               F. Adolescents (12 –18 years)
B. Infant (30 days – 1 year)                                       G. Young adults (18 – 39 years)
C. Toddler (1-3 years)                                             H. Middle adults (39 – 64 years)
D. Preschooler (3-5 years)                                         I. Older adults (64+)
E. School age children (5 – 12 years)
EXPERIENCE WITH AGE GROUPS:                                       A       B         C       D       E     F       G                     H             I
Able to adapt care to incorporate normal growth and
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

My experience is primarily in: (Please indicate number of years.)
Medical                                           Year (s)                 Oncology                                              Year   (s)
Surgical                                          Year (s)                 Neurology                                             Year   (s)
Telemetry                                         Year (s)                 Psychiatry                                            Year   (s)
Orthopedics                                       Year (s)                 Rehabilitation                                        Year   (s)
Other:                                            Year (s)

I certify that all of the above information is correct and that any misrepresentations or falsification of fact may be considered sufficient
cause for immediate dismissal from Cornice, Inc. I have completed this skills checklist to the best of my knowledge and agree that all of
this information provided is correct.

Print: LAST NAME ___________________________ FIRST ____________________ DATE __________________


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