Southville International School and Colleges

COLLEGE OF NURSING

CI's Signature
Simulated Observed Performed
BASIC NURSING CLINICAL SKILLS CHECKLIST
Skills Lab RLE RLE
A. Vital Signs      
1 Pulse rates and sites      
2 Respiratory rate and quality      
3 Blood pressure: manual, palpation, electronic      
4 Temperature: axilla, oral, rectal, tympanic      
5 Pain Scale      
Physical Assessment:      
B. The student will perform examination using inspection, auscultation,      
palpation and percussion.      
1 Skin, hair, nails      
2 Eyes, vision      
3 Ears      
4 Nose and sinuses      
5 Mouth and throat      
6 Neck      
7 Neck vessels      
8 Lungs      
9 Heart      
10 Breast and axillae      
11 Abdomen      
12 Muscoskeletal      
13 Peripheral vascular      
14 Neurologic      
15 Health history interview      
C. Pain Management and Assessment      
1 Qualitative and quantitative assessment      
2 Patient controlled analgesia      
3 Relaxation techniques      
4 Body positioning in pain control      
D. Infection Control      
1 Medical Asepsis      
2 Medical Hand washing      
3 Hand Rubbing      
4 Clean gloving      
5 Use of Mask/N95/Eyewear/Face Shield      
6 Surgical Asepsis      
7 Surgical Hand washing      
8 Sterile gloving      

Revised: 6/20/2014
 Southville International School and Colleges
COLLEGE OF NURSING

CI's Signature
Simulated Observed Performed
BASIC NURSING CLINICAL SKILLS CHECKLIST
Skills Lab RLE RLE
9 Gowning      
10 Sterile technique/Sterile field      
11 Others      
12 Sharps disposal      
13 Contaminated material disposal      
14 Cleaning bodily fluid spills      
E. Personal Hygiene and Skin Care      
1 Oral Care      
Mouth Care      
Care of dentures, retainers, bridges      
Dental Flossing      
Oral irrigation      
Trache care      
2 Nasal Care      
Nasal Irrigation      
Ear Care      
3 Ear Irrigation      
Nail care (fingers and toes)      
4 Hair Care/Shampooing      
Pedicolosis Treatment      
5 Bath      
Tub bath      
Bed bath      
Partial bed bath      
Therapeutic bath      
Shower      
6 Perineal Care      
7 Scrotal Care      
8 Foot care      
9 Care of prosthetics (eyeglasses, contacts, eye prosthesis,      
hearing aid, artificial limbs)      
10 Back care      
11 Shaving - Facial hair, pubic hair, body hair      
F. Toileting      
1 Use of bedpan      
2 Use of urinal      
3 Commode      
G. Mobility, Immobility and Positioning      

Revised: 6/20/2014
 Southville International School and Colleges
COLLEGE OF NURSING

CI's Signature
Simulated Observed Performed
BASIC NURSING CLINICAL SKILLS CHECKLIST
Skills Lab RLE RLE
1 Body mechanics      
2 Body alignment      
3 Turning patient      
4 Transferring patient: bed, stretcher, chair      
5 Use of safety devices      
6 Use of restraints      
7 Use of devices to relieve pressure sores      
8 Active range of motion      
9 Passive range of motion      
10 Restrictive Exercises      
11 Leg Exercises      
H. Ambulation      
1 Use of wheelchair      
2 Use of crutches: walking, upstairs, downstairs      
Swing-through gait      
Two-point gait      
Three-point gait      
Four-point gait      
3 Use of cane      
4 Use of walker      
5 Parallel Bar      
I. Positioning for Examination & Treatment      
1 Supine      
2 Prone      
3 Dorsal Recumbent      
4 Lithotomy      
5 Trendelenburg      
6 Proctologic      
7 Fowler's      
8 Sim's      
9 Sitting      
10 Knee Chest      
J. Draping of patient      
K. Bedmaking and Comfort Measures      
1 Bed stripping      
2 Making occupied bed      
3 Making unoccupied bed      
4 Egg-crate (Inflatable/Alternating Pressure Mattress)      

Revised: 6/20/2014
 Southville International School and Colleges
COLLEGE OF NURSING

CI's Signature
Simulated Observed Performed
BASIC NURSING CLINICAL SKILLS CHECKLIST
Skills Lab RLE RLE
L. Comfort Measures      
1 Offering bed pan/urinal      
2 Providing comfort, rest and sleep      
3 Back rub/massage      
4 Applying external warming device      
5 - Bear hugger- warmer      
M. Use of supportive devices      
1 Pillows      
2 Foot rest      
3 Back rest      
4 Sand bags      
5 Handy rolls      
6 Rubber rings      
7 Arm Sling      
8 Trapeze Bar      
9 Use of the call bell      
10 Transporting a patient      
11 ID and allergy bands      
N. I & O Calculation and Recording      
1 Net balance calculation      
O. Genitourinary      
1 Straight catheter insertion/removal      
2 Indwelling catheter insertion      
3 Bladder Instillation      
4 Continuous bladder irrigation      
5 Bladder Training      
6 Catheter removal      
7 Catheter care: indwelling, condom      
8 Assist with pap smear      
9 Assist with pelvic examination      
P. Bowel Elimination      
1 Enema - cleansing, retention, soap suds, carminative, fleet      
2 Selection/Application of ostomy appliances      
3 Ostomy pouch care      
4 Stoma/Peristomal skin care      
5 Ostomy irrigation      
6 Removal of impactions      
Q. Nutrition      

Revised: 6/20/2014
 Southville International School and Colleges
COLLEGE OF NURSING

CI's Signature
Simulated Observed Performed
BASIC NURSING CLINICAL SKILLS CHECKLIST
Skills Lab RLE RLE
1 Nutritional Assessment      
2 Residual Check      
3 Gravity feedings: enteral , gastrostomy      
4 Insertion/Maintenance of enteral feeding tube      
5 Removal of feeding tube (not gastrostomy tube)      
6 Feeding pumps      
R. Wound Management      
1 Clean dressing change      
2 Superficial dressing change (dry, gauze, topical wound products,      
3 with drainage tube.)      
4 Deep wound packing      
5 Wet to dry dressing change      
6 Sterile dressing change      
7 Wound irrigation      
8 Incision and drainage      
9 Suture/Staple removal      
10 Application of binders (abdominal, T-binder, breast)      
S. Heat and Cold Therapy      
1 Care of a patient with fever      
2 Heat Application/Hot Soak      
3 Warm Compress      
4 Cold Application      
5 Tepid Sponge      
6 Sitz Bath      
T. Safe Medication Preparation and Administration      
1 Oral (tablets, capsules, and liquids)      
2 Topicals, intradermal and transdermal      
3 Eye drops, ointment      
4 Ear drops      
5 Nose drops      
6 Nasal sprays      
7 Nasal inhalers      
8 Nebulization      
9 Metered-dose-device; w/ spacer      
10 Oxygenation      
11 Rectal      
12 Vaginal      
13 Subcutaneous      

Revised: 6/20/2014
 Southville International School and Colleges
COLLEGE OF NURSING

CI's Signature
Simulated Observed Performed
BASIC NURSING CLINICAL SKILLS CHECKLIST
Skills Lab RLE RLE
14 Mixing insulins in 1 syringe      
15 Intramuscular      
16 Nasogastric/Gastrostomy      
U. IV Therapy      
1 Tube priming      
2 Set up single and multi IV line configurations      
3 Peripheral IV maintenance      
4 Peripheral IV insertion      
5 Peripheral IV site care      
6 Peripheral IV removal      
7 Central line management      
8 Central venous catheter care      
9 IV tube and bag changes      
10 Use of infusion devices      
11 Regulate flow rate      
12 Heplock flush      
13 IV medication push      
14 IV piggyback medication      
15 IV meds via soluset      
16 IV meds via saline lock/heplock      
17 IV meds thru central line      
18 IV meds thru portha catheter      
19 Assessment for inflammation/infiltration      
20 Blood Transfusion:      
Peparing forms, cross-checking      
Monitoring of transfusion reaction      
Whole Blood Cells/Packed cells/ Plasma      
21 Total parenteral nutrition (TPN) administration      
22 Assist in Cut down      
V. Immunization      
1 BCG      
2 DPT      
3 Polio      
4 Measles      
5 Tetanus Toxoid      
6 Hepa B      
7 Anti- rabies      
8 Hypersensitivity test      

Revised: 6/20/2014
 Southville International School and Colleges
COLLEGE OF NURSING

CI's Signature
Simulated Observed Performed
BASIC NURSING CLINICAL SKILLS CHECKLIST
Skills Lab RLE RLE
W. Specimen Collection      
1 Blood specimen/phlebotomy      
2 Sputum specimen (oral/tracheostomy)      
3 Stool specimen      
4 Urine Specimen      
5 Gastric specimen from nasogastric tubes (gastrocult)      
6 Wound culture      
7 Glucose testing/fingerstick      
8 Central line/ intravenous catheter      
9 Porta catheter/subcutaneous      
X. Tubes and Drains      
1 Insertion of nasogastric tube      
2 Nasogastric tube maintenance      
3 Gastrostomy tube maintenance      
4 Care of drainage collection device(s): JP drains, hemovacs, Penrose      
5 Care of dialysis tubes: IJ Cath, AV Cath, peritoneal      
Y. Respiratory Care      
1 Pulse oximeters      
2 Use of ambu bag/mask      
3 Turn, cough, and deep breathe      
4 Postural drainage/chest physiotherapy      
5 Incentive spirometry      
6 Oxygen therapy:      
Nasal cannula      
O2 mask      
O2 tent      
Re-breathable mask      
Croupette      
7 Assisted ventillation      
IPPB      
Bennet's respirator      
Emerson's respirator      
Bird's respirator      
8 Suctioning      
Nasal      
Oral      
Endotracheal      
Tracheal      

Revised: 6/20/2014
 Southville International School and Colleges
COLLEGE OF NURSING

CI's Signature
Simulated Observed Performed
BASIC NURSING CLINICAL SKILLS CHECKLIST
Skills Lab RLE RLE
9 Closed chest tube drainage system care      
10 Chest tube insertion site care/Thoracostomy Care      
11 Tracheostomy care      
Z. Mental Health      
1 Self-awareness and appropriate self-disclosure      
2 Mental status examination:      
Apperance and behavior      
Mood and affect      
Thought processes & perception      
Cognitive functions & sensorium      
3 Therapeutic communication skills      
4 Evaluate risk for suicide      
5 Evaluate risk for violence      
AA
. Care of the Dying & Post-mortem Care      
1 Care for the Dying      
2 Care after Death      
AB. Patient Safety      
1 Self reporting of errors and near-misses      
2 Risk for Falls Assessment      
3 WHO-Surgical Safety Checklist      
AC. Communication among Health Practitioners      
1 Charting      
Narrative      
POMR - SOAP      
FDAR      
2 Discharge of patients      
3 Transfer of patients      
4 Referrals-SBAR      
5 Endorsement      

Revised: 6/20/2014