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Candidate:Discipline:Checklist:Date Signed:Signature:Candidate's Name
LPNLong Term Care LVN/LPN04/09/2024'Candidate's Name  04/09/2024 2:07PMLimited ExperienceMid-level ExperienceAdvanced-level Experience123Assessment/ Patient CareGeneral 3.0EMR Software 1.7Cardiovascular 3.0Endocrine/Metabolic 3.0Gastrointestinal 3.0Immunology/Hematology/Oncology 2.6Musculoskeletal 2.7Neurological 3.0Pulmonary 3.0Renal/ Genitourinary 2.7Wounds/ Integument 2.9Medication/ Therapeutic InterventionsBlood 1.0IV Therapy 2.8MedicationsAdministration3.0Nutritional Therapy 3.0Oxygen Administration 2.8Pain Management 2.5Procedures/ EquipmentPerform 2.7Specimen Collection 3.0Isolation and InfectionPrevention2.3Age Group ExperienceAge Groups 3.0Clinical Settings 3.0Candidate's Name , LPN Long Term Care LVN/LPN[1] Limited [2] Mid-level [3] Advanced-levelAssessment/ Patient CareGeneralEMR SoftwareAdmission 3Advance Directives 3Collect Appropriate Data 3Long Term Care Plan 3MDS Forms 3Medicare Survey 3Out of Hospital DNR 3Patient and FamilyTeaching3Allscripts 1American HealthTech 1Athenahealth 2CareMatrix 1CERNER 2eClinicalWorks 2EPIC 2Meditech 1EMR Software (cont.)CardiovascularEndocrine/MetabolicPointClickCare 3Sorian 2Abnormal HeartSounds/Murmurs3Auscultation (Rate,Rhythm)3Capillary Refill 3Color 3Coagulation Studies 3Vital Sign Monitoring 3Acute MI 3AICD (AutomaticImplantedCardioverter/Defibrillator)3Angina 3Cardiac Arrest/ CPR 3Cardiomyopathy 3Congestive Heart Failure 3Hypertension 3Hypovolemic Shock 3Pacemaker (Permanent) 3Candidate's Name , LPN Long Term Care LVN/LPN[1] Limited [2] Mid-level [3] Advanced-levelEndocrine/Metabolic (cont.)GastrointestinalImmunology/Hematology/OncologyBlood Glucose 3Diabetes 3Diabetic Ketoacidosis 3Drug Overdose 3Bowel Sounds 3G.I. Assessment 3Nutritional Status 3Bowel Obstruction 3Colostomy 3GI Bleeding 3Hepatitis 3Ileostomy 3Liver Cancer 3Liver Failure 3Pancreatic Cancer 3Pancreatitis 3Blood Transfusions 2Immunology/Hematology/Oncology (cont.)MusculoskeletalNeurologicalHematology 3Acute Leukemia 3Cancer 3Chemo/ Radiation 1HIV/ AIDS 3Sepsis 3Treatment Side Effects 3Cast Care 3Pulse/Circulation Checks 3Traction 1Amputation 3External Fixation 3Paraplegia/ Quadriplegia 3Joint Replacement 3Level of Consciousness 3Neurological Assessment 3Reflex/ Motor Deficits 3Candidate's Name , LPN Long Term Care LVN/LPN[1] Limited [2] Mid-level [3] Advanced-levelNeurological (cont.)PulmonaryRenal/ GenitourinaryAlzheimer's Disease 3Coma 3CVA 3Neuromuscular Disease 3Seizure Disorder 3Spinal Cord Injury 3Assess Lung Sounds 3Oxygenation Status 3Rate and Work ofBreathing3Asthma 3COPD 3COVID 3Pneumonia 3Pulmonary Edema 3Pulmonary Embolism 3Tracheostomy 3Tuberculosis 3Renal/ Genitourinary (cont.)Wounds/ IntegumentFluid Status 3BUN and Creatine 3Serum Electrolytes 3Fluid Balance 3Measurement of I & O 3End Stage Renal Disease 3Fistula/ Shunt 3Hemodialysis 2Peritoneal Dialysis 1Suprapubic Catheter 3Urinary Tract Infection 3S/S Infection 3Skin Assessment 3Skin Breakdown 3Burns 2Staged Decubitus Ulcers 3Stasis Ulcers 3Surgical Wounds withDrains3Candidate's Name , LPN Long Term Care LVN/LPN[1] Limited [2] Mid-level [3] Advanced-levelWounds/ Integument (cont.)Medication/ Therapeutic InterventionsBloodIV TherapyMedications AdministrationNutritional TherapyWounds 3Administer Blood/ BloodProducts1Administer IV Medications 3Assess/ Maintain IV Site 3Infusion Pumps 3IV Insertion 3Vascular Access DevicesCare/ Maintenance2Administer IM and SQMedication3Administer InhalationMedication3Administer POMedications3Bladder Irrigation andInstillation3Dobhoff Tube Insertion 3Enteral Administration 3Gravity/ Bolus TubeFeedings3Nutritional Therapy (cont.)Oxygen AdministrationPain ManagementProcedures/ EquipmentPerformJ-tube 3NGT Insertion 3PEG 3Tube Feeding Pumps 3Nasal Cannula 3Portable Oxygen 3Tracheostomy Tube 3External CPAP/BIPAP 3High Flow Nasal Cannula(HFNC)3Interpretation of ABGs 2Assess Pain Level/Tolerance3Patient ControlledAnalgesia2Doppler 2Dressing Changes 3Establish/ Protect Airway 1Candidate's Name , LPN Long Term Care LVN/LPN[1] Limited [2] Mid-level [3] Advanced-levelPerform (cont.)Specimen CollectionFoley (Female) 3Foley (Male) 3Isolation 3Nerve Stimulators 2Specialty Beds 3Suctioning (Oral-Nasopharynx)3Tracheostomy Care/Suctioning3Wound Care 3Wound Irrigations 3Wound Vac 3Central-Line Blood Draw 3Clean Catch Urine 3Cultures (Blood, Sputum) 3Finger Stick 3Sterile Urine 3Stool 3Throat Swab 3Venipuncture 3Isolation and Infection PreventionAge Group ExperienceAge GroupsClinical SettingsCAPR Respirator 1Contact Precautions 3Droplet Precautions 3N95 Masks 3PAPR Respirators 1Standard Precautions 318 - 39 Years 339 - 64 Years 364+ Years 3Assisted Living 3Memory Care Unit 3Nursing Home 3Skilled Nursing Unit 3