Skill Checklists
Dietitian
Name
Email
LAST 4 OF SSN
This checklist was electronically signed on (Today’s date)
Instructions: This checklist is meant to serve as a general guideline for our client facilities as to the level of your skills within your nursing specialty. Please use the scale below to describe your experience/expertise in each area listed below.
Proficiency Scale:
1 = No Experience
2 = Need Training
3 = Able to perform with supervision
4 = Able to perform independently
Newborn/Neonate (birth to 30 days)
Infant (1 month to 1 year)
Toddler (1 year to 3 years)
Preschooler (3 years to 5 years)
School Age Child (5 years to 12 years)
Adolescents (12 years to 18 years)
Young Adults (18 years to 39 years)
Middle Adults (39 years to 64 years)
Older Adult (64 years to 79 years)
Elderly Adult (over 70+ years)
Standard Precautions
Isolation Precautions
Pediatric Respiratory/Cardiac Arrest
Adult Respiratory/Cardiac Arrest
Crash Carts
Defibrillators
Patient and Family Education
Electronic Documentation
Managing Food-Drug Interactions
Managing Food-Drug Timing
Managing Nutrition Therapy Complications
Develop Plan of Treatment
Document Refusal of Care
Document Non-Compliance
Determine Usual or Adjusted Body Weight
Determine Energy Requirements
Determine Protein Requirements
Determine Fluid Requirements
Determine Electrolyte Requirements
Determine Fat Requirements
Determine Micronutrient Requirements
Perform Nutrition Education
Perform Nutrition Assessments
Clinic Malnutrition
Poor Diet
Eating Difficulties
Marginal Malnutrition
Metabolic Demands
Nutrient Deficiencies
Assess Fluid Status
Kwashiorkor
Marasmus
Cachexia
Protein Calorie Malnutrition
Abdominal Wounds and Surgeries
Abnormal Bleeding
Acute MI
Acute Renal Failure
Alzheimer's Disease
Anorexia Nervosa
Aspiration
Bulimia
Cancer
Chronic Diarrhea
Coma
Congenital Heart Defects
Congestive Heart Failure
COPD
CVA
Decubitus
Diabetes
Diabetic Ketoacidosis
Draining Abscesses
Draining Wounds
Drug Overdose
Dysphagia
Elevated Cholesterol/Triglycerides
End Stage Renal Disease
Epiglottitis
Excessive Alcohol Intake
Extensive Burns
Failure to Thrive
Fever
Fistulae
Hemodialysis
Hepatitis
HIV/AIDS
Homelessness/Limited Access to Food
Hyperemesis
Infection
Inflammatory Bowel Disease
Liver Failure
Low Blood Sugar
Major Surgery
Malabsorption Syndromes
Mucositis
Pancreatitis
Peritoneal Dialysis
Pregnancy
Protracted Emesis
Radiation
RDS
Refeeding Syndrome
Renal Transplants
Sepsis
Short Gut Syndrome
Sickle Cell Anemia
Status Asthmaticus
Stomatitis
Transplants
Trauma
Tuberculosis
Vented Patient
Wounds
Morbid Obesity
Post-Op Gastric Stapling/Gastric Bypass
Depression
Steroids
Immunosuppressants
Antineoplastics
Insulin
Diuretics
Blood Thinners
Laxatives
LFT's
Serum Ammonia
Serum Amylase
Cholesterol
BUN
Serum Electrolytes
Blood Glucose
Hematology
Creatinine
Albumin
Pre-Albumin
C-Reactive Proteins
Nitrogen Balance
Acid/Base Balance
Protein-Energy Balance
Vitamins and Minerals
Oral Diets
Enteral Nutrition
Parenteral Nutrition
Writing Orders for Nutrition
Intake and Output
Fluid Balanace
Calorie Counts
Small Bowel Feeding Tubes
Gastrostomy Tubes
Jejunostomy Tubes
Hospital
Clinic
Long Term Care
Retirement Center
Hospice
Home Health
Research
Daycare
Correctional Facility
Restaurant
Public Health
Community Programs
I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
