LPN Checklist

Please provide the following information in the form

Name *

Date of Hire

1 = Clinicals Only

2 = Some Experience

3 = Experienced

4 = Can Perform Task Independently

Neurological System

NEURO ASSESSMENT/NEURO VITALS *1234

HALO TRACTION *1234

SEIZURE PRECAUTIONS *1234

SPINAL CORD INJURY *1234

HEAD INJURY *1234

PRE / POST NEUROLOGICAL SURGERY *1234

REHABILITATION OF THE NEURO PATIENT *1234

CNS INFECTIONS *1234

PARKINSONS *1234

AUTONOMIC DYSREFLEXIA *1234

ALZHEIMERS *1234

CHRONIC C.V.A / T.I.A *1234

USING GLASCOW COMA SCALE *1234

Cardiovascular

CAPILLARY REFILL *1234

EDEMA *1234

HEART TONES *1234

PULSES *1234

ANGINA (ACUTE AND CHRONIC) *1234

ASSESSING AND TREATING ORTHOSTATIC BP *1234

ASSESSING ABNORMAL HEART TONES *1234

ANTIEMBOLIC DEVICES *1234

Patients with Respiratory Problems

Assessing the Respiratory System including:

BREATH SOUNDS *1234

BREATHING PATTERN / EFFORT *1234

COUGH EFFORT *1234

SKIN AND NAIL BED COLOR *1234

SPUTUM (COLOR/CHARACTER) *1234

Care and Maintenance of:

ACUTE AIRWAY *1234

NASOPHARYNGEAL AIRWAY *1234

OROPHARYNGEAL AIRWAY *1234

Administering and Monitoring O2 including:

NASAL CANNULA *1234

MASK *1234

O2 SATS *1234

DEMONSTRATING PROPER USE OF AMBU BAG *1234

Care of Ventilator Dependent Patient:

SUCTIONING: LENGTH OF TIME SUCTIONING *1234

HYPERVENTILATION *1234

VENTILATOR SETTINGS *1234

DOCUMENTATION *1234

Caring for a Patient with:

RESPIRATORY FAILURE *1234

RESPIRATORY INFECTIONS *1234

STATUS ASTHMATICUS *1234

RESPIRATORY DISTRESS SYNDROME *1234

PULMONARY EDEMA *1234

PULMONARY EMBOLI *1234

TENSION PNEUMOTHORAX *1234

TRACHEOSTOMY *1234

USE OF INCENTIVE SPIROMETER *1234

Gastrointestinal

ASSESSING BOWEL SOUNDS *1234

IDENTIFYING ABNORMALITIES *1234

CARING FOR PATIENT ON TOTAL PARENTERAL NUTRITION *1234

INSERTING /MAINTAINING FEEDING TUBES (NG) *1234

ADMINISTERING TUBE FEEDINGS *1234

ABDOMINAL WOUNDS OR INFECTIONS *1234

ILEOSTOMY/COLOSTOMY *1234

STOOL TESTS *1234

I&O: SHIFT VOLUMES AND TOTALS INCLUDING MARKING AND/ *1234

OR MEASURING AMOUNTS OF URINE, GASTRIC FLUID *1234

NG DRAINAGE, EMESIS, DIARRHEA *1234

Genitourinary / Renal

INSERTING/MAINTAINING URINARY DRAINAGE TUBES: *1234

INSERTION OF FOLEY *1234

MANAGING UROSTOMY *1234

MANAGING SUPRAPUBIC CATHETER *1234

PLACING CONDOM CATHETER *1234

CARING FOR PATIENTS WITH CHRONIC RENAL FAILURE *1234

CARING FOR PATIENT RECEIVING DIALYSIS *1234

ASSESSING FLUID AND ELECTROLYTE PROBLEMS *1234

KNOWLEDGE OF UA VALUES *1234

COLLECTING SPECIMENS *1234

Endocrine

Caring for the Diabetic Patient:

CHECKING CAPILLARY BLOOD GLUCOSE *1234

DIABETIC TEACHING *1234

TREATING HYPO/HYPERGLYCEMIA *1234

INSULIN ADMINISTRATION *1234

HORMONE THERAPY *1234

Muscuskeletal

TRACTION *1234

BRACES *1234

CASTS *1234

COLLARS *1234

SLINGS/SPLINTS *1234

SKELETAL AND SKIN TRACTION *1234

Beds:

CLINITRON *1234

ROTO REST *1234

CRUTCH WALKING/WALKERS *1234

CIRCELECTRIC *1234

ARTHROSCOPY/ARTHROTOMY *1234

Caring for Patients with:

JOINT/BONE DISORDERS *1234

TOTAL KNEE REPLACEMENT *1234

TOTAL HIP REPLACEMENT *1234

AMPUTATION *1234

Vital Signs and Weights

Obtaining and Recording:

BP, INCLUDING ORTHOSTATIC *1234

PULSE, RADIAL *1234

TEMPERATURE, ORAL *1234

TEMPERATURE, RECTAL *1234

RECOGNIZING CARDIAC ARREST *1234

CARDIOVERSION DEFIBILATION *1234

ACTIVATING CODE TERM *1234

BRINGING EMERGENCY EQUIPMENT TO ROOM *1234

DNR STATUS *1234

TEMPERATURE, AXILLARY *1234

TEMPERATURE, TYMPANIC *1234

RESPIRATIONS *1234

WEIGHT, POUNDS AND KILOGRAMS *1234

Use of Electronic VS equipment:

APPLYING OXIMETER *1234

ELECTRONIC THERMOMETER *1234

AUTOMATIC BP MACHINE (DYNAMAP) *1234

Scale Use:

STANDING *1234

CHAIR *1234

BED *1234

RECODING AND REPORTING INFORMATION *1234

Hygiene / Skin

RISK FACTORS FOR SKIN BREAKDOWN *1234

OBSERVING, RECORDING AND REPORTING PRESSURE POINTS FOR REDNESS OF BREAKDOWN *1234

RECORDING AND REPORTING HYGIENE/SKIN//BREAKDOWN *1234

Bathing/Daily Hygiene:

BATHING (SHOWER/TUB/ARJO) *1234

USE OF SHOWER CHAIR *1234

USE OF BATH/SHOWER BOAT *1234

ORAL CARE INCLUDING PATIENTS WHO ARE NPO, COMATOSE, WITH DENTURES *1234

PERI CARE *1234

FOOT CARE FOR PATIENTS WITH IMPAIRED CIRCULATION OF SENSATION *1234

INCONTINENCE CARE *1234

SHAVING AND PRECAUTIONS *1234

Use of Pressure and Friction Reduction Devices:

SPECIAL BEDS/MATTRESSES *1234

HEELS AND ELBOW PROTECTION *1234

FOOT CRADLES *1234

Nutrition

ESTIMATING INTAKE *1234

SETTING UP FOR MEALS *1234

ASPIRATION PRECAUTIONS *1234

NOURISHMENTS *1234

FEEDING PATIENTS *1234

COUNTING CALORIES *1234

FLUID RESTRICTION *1234

NPO *1234

RECORDING AND REPORTING NUTRITIONAL INFORMATION *1234

Care Routine

New Admissions and Transfers:

ROOM PREPARATION *1234

VS. HEIGHT AND WEIGHT *1234

INVENTORY AND DISPOSITION OF BELONGINGS *1234

ROOM ORIENTATION, CALL BELL *1234

BASIC COMFORT MEASURES *1234

PREPARING FOR AND EXPLAINING ROUTINES TO PATIENT *1234

POST MORTEM CARE *1234

Safety and Activity

DETERMINING PATIENT ID *1234

IDENTIFYING/RESPONDING TO SAFETY HAZARDS *1234

DETERMINING NEED FOR ADDITIONAL HELP *1234

Recognizing Abuse:

SUBSTANCE *1234

PHYSICAL *1234

EMOTIONAL *1234

MAINTAINING CLEAN , ORDERLY WORK AREA *1234

HANDLING HAZARDOUS MATERIALS *1234

PROPER BODY MECHANICS *1234

ROM EXERCISES *1234

TRANSFER TO BED, WC, COMMODE WITH OR WITHOUT DEVICE *1234

TURNING AND POSITIONING *1234

REPORTING BROKEN EQUIPMENT *1234

AMBULATING WITH OR WITHOUT DEVICE *1234

PATIENT SAFETY MODULE *1234

USE OF HOYER LIFT (DEXTRA/MAXI) *1234

BED OPERATION *1234

USE OF WHEEL LOCKS *1234

USE OF ALARMS (BED, PATIENT, UNIT) *1234

USE OF CALL LIGHT *1234

APPLICATION AND DOCUMENTATION OF RESTRAINTS: BELT, INCLUDING SEAT BELT WRIST/ANKLE VEST USE OF SEIZURE PADS *1234

Infection Control

Proper Use of Specific Barrier Methods:

GLOVES *1234

GOWN *1234

MASK/GOGGLES *1234

PROTECTIVE/REVERSE ISOLATION *1234

BRODY SUBSTANCE ISOLATION *1234

TB PRECAUTIONS *1234

MRSA PRECAUTIONS *1234

HAND WASHING *1234

INFECTIOUS/HAZARDOUS WASTE DISPOSAL *1234

SUPPLY/EQUIPMENT DISPOSAL *1234

USE OF DISPOSABLE THERMOMETER *1234

USE OF CPR MASK/BAG *1234

DISPOSAL OF SHARPE *1234

Line Skills

VENIPUNCTURE FOR SPECIMEN *1234

ADMINISTERING BLOOD AND BLOOD PRODUCTS *1234

IV Therapy Including:

STARTING IV *1234

CHANGING IV SITES *1234

CHANGING IV DRESSINGS *1234

CHANGING IV TUBING *1234

ADMINISTERING FLUIDS ON CONTINUOUS IV PUMPS *1234

SETTING UP AND MONITORING PCA *1234

OBTAINING CENTRAL VENOUS/PERIPHERAL VENOUS BLOOD *1234

USING PICC, HICKMAN, TRIPLE LUMEN CATHS *1234

SET UP AND MONITORING FOR TPN *1234

Medication and Administration

CIMETIDINE (TAGAMET) *1234

DIAZEPAM (VALIUM) *1234

DURAMORPH *1234

FUROSEMIDE (LASIX) *1234

HEPARIN *1234

INSULIN *1234

TERBUTALINE *1234

THEOPHYLLINE *1234

VERAPAMIL (CALAN) *1234

ORAL MEDICATIONS *1234

LORAZEPAM (ATIVAN) *1234

MORPHINE *1234

NALOXONE (NARCAN) *1234

NITROGLYCERINE *1234

PENTOBARBITAL *1234

PHENYTOIN (DILANTIN) *1234

POTASSIUM CHLORIDE *1234

TOPICAL MEDICATIONS *1234

Suppositories:

VAGINAL *1234

RECTAL *1234

ORDERING MEDS *1234

Other Skills

PROVIDING EDUCATION TO PATIENT FAMILY RELATED TO MEDICAL CONDITION, SELF CARE AND HEALTH CARE HABITS *1234

USING COMPUTERIZED TOOLS EFFECTIVELY *1234

Communication

USING APPROPRIATE ABBREVIATIONS *1234

IDENTIFYING NEED FOR ALTERNATE COMMUNICATING MECHANISMS *1234

Communicating to Charge RN:

CHANGES IN PATIENT CONDITION *1234

PATIENT NEEDS, COMPLAINTS AND CONCERNS *1234

UNUSUAL INCIDENTS *1234

REINFORCING RN TEACHING WITH PATIENT *1234

SELECTING AND USING FORMS APPROPRIATELY *1234

USING ALTERNATE COMMUNICATION TOOLS/DEVICES *1234

Unit Activity

IDENTIFYING UNUSUAL INCIDENTS ON THE UNIT THAT REQUIRE REPORTING *1234

LOCATING AND USING APPROPRIATE REFERENCE MATERIALS *1234

COMPLETING RISK MANAGEMENT REPORTS AS NEEDED *1234

CHARGING FOR PATIENT CARE ITEMS *1234

OBTAINING NEEDED SUPPLIES AND EQUIPMENT *1234

USING TELEPHONE SYSTEM *1234

Miscellaneous

Knowledge of Serum Lab Values Including:

CHEM 7, CHEM 10 *1234

CBC *1234

SERUM DRUG LEVELS *1234

PAIN MANAGEMENT *1234

CARING FOR DRAINS/TUBES (I.E. HEMOVAC, PENROSE) *1234

MONITORING AND ASSESSING I & O *1234

PERFORMING COMPLEX DRESSING CHANGES *1234

ALERT CHARTING *1234

Confirmation

Full Name *

DATE

06/02/2026

Please do not fill in this field.

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