ACLS-Tachy CHECKLIST (2) PDF - LPU Performance Evaluation Checklist (NCM 118)
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Summary
This document contains a performance evaluation checklist for a clinical or practical exam covering advanced cardiovascular life support. The checklist addresses specific criteria for evaluation of team leaders, tachycardia, VF/ Pulseless V-tach management and PEA (pulseless electrical activity) Management.
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FM-LPU-NRSG-06/05 College of Nursing Telephone No. (043) 723-0706 loc. 109 / 110...
FM-LPU-NRSG-06/05 College of Nursing Telephone No. (043) 723-0706 loc. 109 / 110 PERFORMANCE EVALUATION CHECKLIST NCM 118 – Critical Care and Emergency Nursing Advanced Cardiovascular Life Support Name of Student: ________________________________________________ Year / Clinical Group: ______________ Rating______________ Legend: 2 Progress Acceptable (Performance is usually effective and efficient) 1 Needs Improvement (Progress in performance is too slow to judge satisfactorily; task performance is not done properly for majority of the time) CRITERION PASS REPEAT REMARKS Team Leader 1. Ensure high quality CPR at all times 2. Assign team member roles 3. Ensure team members perform well Tachycardia Management 1. Start oxygen if needed, place monitor, start IV 2. Place monitor in proper position 3. Recognize symptomatic tachycardia 4. Administer correct dose of amiodarone/adenosine 5. Prepare for second line of treatment VF/Pulseless V-tach Management 1. Recognize VF 2. Clear before analyze and shock 3. Immediately resume CPR after shocks 4. Appropriate airway management 5. Appropriate cycle of drug – rhythm check/ shock- CPR 6. Administer appropriate drug(s) and doses PEA MANAGEMENT 1. Recognize PEA 2. Verbalize potential reversible cause of asystole/PEA/ (H’s & Ts) 3. Administer appropriate drugs and doses 4. Immediately resume CPR after rhythm checks POST CARDIAC ARREST CARE 1. Identify ROSC 2. Ensure BP, 12 lead ECG were perform, O2 sat is monitored, advance airway and waveform capnography & lab test 3. Targeted Temperature management SCORE Over-all Performance Rating ____________________ % Evaluatee: Evaluator: _________________________________ ________________________________________ Signature of Student Over Printed Name Signature of Clinical Instructor Over Printed Name Date__________________________ Date__________________________ PREPARED BY: VERIFIED BY: DR. MARIO R. MARASIGAN RN, MAN DR. BELLA P. MAGNAYE, RN, MAN Faculty Department Chairman APPROVED BY: DR. CECILIA C. PRING Dean College of Nursing Capitol Site, Batangas City Telephone No. +6343 723-0706 / 2441 Fax No. 723-0595 www.lpu.edu.ph