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Hudson Staffing Travel Nurses| Oncology Online Checklist
Oncology Online Checklist
Thank you for your decision to apply for a travel nursing position with
Hudson Staffing
! Before we can offer you a nursing employment opportunity in the Oncology field, an electronic skills assessment must be completed. Please, complete the nursing skills checklist below, and be sure to review your information thoroughly before clicking the submit button.
GENERAL INFORMATION
Note:
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Please enter your full name as it appears on your Social Security Card:
First Name
Middle Name
Last Name
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Please enter the Last Four digits of your Social Security Number:
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Please check here if you do not hold a valid social security card.
Please provide your contact information:
Phone Number
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E-mail Address
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Type your e-mail address again above.
This profile is for use by healthcare professionals in the Oncology discipline and specialty.
It will not be a determining factor for the program.
CHECKLIST INSTRUCTIONS
Please mark your level of experience
1. No theory and/or experience
2. Limited experience/need supervision and/or support
3. Experienced/minimal support needed to perform
4. Proficient/can perform independently
MEDICATIONS / IV THERAPY
1
2
3
4
Administer PO Medications
Administer IM / SQ Medications
Administer IV Medications
Needle-less Systems
Infusion Pumps
Establish Peripheral IVs
Discontinue Peripheral IVs
Pain Assessment / Management
Draw Blood for Lab Studies
Admin Blood / Blood Products
Central Venous Lines (CVL)
Hickman / Broviac Catheters
PCA / CADD
Port-A-Cath
Infusaid
Infuse-A-Port
CARE OF ONCOLOGICAL PATIENT
1
2
3
4
Head, Neck, Chest
Hematologic System
Gastrointestinal Tract
Reproductive System
Skin (Melanomas / Nonmelanomas)
Urinary Tract
EMERGENCIES
1
2
3
4
Cardiac Tamponade
Dissesminated Intravascular Coagulation
Hypercalcemia
Organ Obstruction
Sepsis
Spinal Cord Compression
Superior Vena Cavae Syndrome
Tumor Lysis Syndrome
FAMILY / PSYCHOSOCIAL NEEDS
1
2
3
4
Patient / Family Education
Advance Directives
Acute Phase
Chronic Phase
Terminal Phase
Bereavement Phase
After Treatment (Survivorship)
ANTINEOPLASTIC AGENTS
1
2
3
4
Bleomycin
Dactinomycin (Actinomycin)
Daunorubicin (DaunoXome)
Doxorubicin (Adriamycin)
ROUTS OF ADMINISTRATION
1
2
3
4
Oral / SQ / IM
Oral / SQ / IM
Intraarterial
Intrathecal / Intraventricular
Intraperitoneal (Tenckhoff Catheter)
Intrapleural
Intravesicular
ALKYLATING AGENTS
1
2
3
4
Bulsulfan (Myleran)
Chlorambucil (Leukeran)
Cisplatin (Platinol)
Cyclophosphamide (Cytoxan)
Mechlorethamine (Mustargen)
ANTIMETABOLITES
1
2
3
4
Cytarabine (Ara-C)
Fluorouracil (5-FU)
Mercaptopurine (6-MP)
Methotrexate
Leucovorin Rescue Protocol
ANTINEOPLASTIC ANTIBIOTICS
1
2
3
4
Bleomycin
Dactinomycin (Actinomycin)
Daunorubicin (DaunoXome)
Doxorubicin (Adriamycin)
Plant Alkaloids
Paclitaxel (Taxol)
Vinblastine (Velban)
Vincristine (Oncovin)
HORMONAL ANTINEOPLASTICS
1
2
3
4
Leuprolide (Lupron)
Megestrol (Megace)
Tamoxifen (Nolvadex)
Testolactone (Teslac)
STAFF MINIMIZE RISK OF EXPOSURE
1
2
3
4
During Preparation
During Administration
During Disposal
CLASSIFICATION OF NEOPLASMS
1
2
3
4
Staging - TNM System
Tissue of Origin
Biologic Behavior
Degree of Cell Differentiation
RADIATION THERAPY (RT)
1
2
3
4
Electromagnetic (Xrays, Gamma Rays)
Particulate (Alpha, Beta)
External Beam Therapy
Knowledge of Early Effects of RT
Knowledge of Interim. Effects of RT
BRACHYTHERAPY (SEALED SOURCES)
1
2
3
4
Interstitial Radiation Therapy
Intracavitary Radiation Therapy
RADIOPHARMACEUTICAL (UNSEALED SOURCES)
1
2
3
4
Tracer Dose
Therapeutic Dose
SURGICAL INTERVENTION
1
2
3
4
Curative Surgery
Diagnostic Surgery
Mechanical Device Insertion
Palliative Surgery
Prophylactic Surgery
Reconstructive Surgery
Rehabilitative Surgery
Bone Marrow Transplant - Allogenic
Bone Marrow Transplant - Syngenic
ONCOLOGY HEALTH CARE SETTINGS
1
2
3
4
Adult
Pediatrics
Cancer Center
Radiation Oncology
Surgical Oncology
Bone Marrow Unit
Research / Clinical Trials
Subacute / Skilled Nursing
Home Health Care
Hospice
Clinic - Risk Assess / Screening / Diagnosis
Clinic - Surgery / Gyn
Clinic - Medical / Hematology
Clinic - Immunology / Infectious
RECOGNITION & MANAGEMENT OF
1
2
3
4
Anxiety / Depression
Metabolic Alterations
Hypersensitivity
Fatigue
HEMATOPOIETIC
1
2
3
4
Anemia
Leukopenia
Thrombocytopenia
GASTROINTESTINAL
1
2
3
4
Anorexia / Dehydration
Nausea / Vomiting
Constipation / Diarrhea
Muscositis / Ulceration
Hepatic Toxicity
Integumentary
Alopecia
Dermatitis
Hyperpigmentation
Genitourinary
Cystitis
Renal Toxicity
CARDIOVASCULAR
1
2
3
4
Cardiac Toxicity
Phlebitis
Extravasation
NEUROLOGIC
1
2
3
4
Neurotoxicity
Ototoxicity
Metabolic Encephalopathy
Peripheral Neuropathy
PULMONARY
1
2
3
4
Fibrosis
Pneumonitis
Edema
REPRODUCTIVE
1
2
3
4
Infertility
Changes in Libido
Erectile Dysfunction
NUTRITION
1
2
3
4
Assess Nutritional Status
Assess / Manage Nutritional Impairment
Interpretation of Lab Values
Oral Feedings
Enteral Tube Feeding
Peripheral Parenteral Nutrition (PPN)
Central TPN
Please read and agree to the statements below by marking the checkbox.
You will not be able to submit until you have marked the checkbox.
*
I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize Hudson Staffing to release this Oncology Skills Checklist to the client facilities in relation to consideration of employment as a healthcare professional with those facilities.
Privacy Note:
Hudson Staffing will record anonymous electronic information about your connection when you click on the submit button. This information is used for security purposes only. This information will include your IP Address (3.221.159.255) which will be used as a digital signature.
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