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ACLS Skills Lab Checklist for Nursing

The document is an Advanced Cardiac Life Support (ACLS) Algorithm Checklist for nursing students at Universidad De Dagupan. It outlines the skills and procedures for managing life-threatening conditions, including primary survey assessments, CPR, and specific interventions for various cardiac rhythms. The checklist is designed for evaluation by instructors and includes sections for student names, group information, and preceptor comments.

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Marissa RJ Cruz Tanael
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14 views5 pages

ACLS Skills Lab Checklist for Nursing

The document is an Advanced Cardiac Life Support (ACLS) Algorithm Checklist for nursing students at Universidad De Dagupan. It outlines the skills and procedures for managing life-threatening conditions, including primary survey assessments, CPR, and specific interventions for various cardiac rhythms. The checklist is designed for evaluation by instructors and includes sections for student names, group information, and preceptor comments.

Uploaded by

Marissa RJ Cruz Tanael
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Universidad De Dagupan

Arellano St., Dagupan City


School of Health Sciences-College of Nursing

NCM 118 (Care of Clients with Life-Threatening Conditions, Acutely Ill/Multi-organ


Problems, High Acuity & Emergency Situations) SKILLS LAB
A.Y. 22-23, First Semester

Advanced Cardiac Life Support (ACLS) Algorithm Checklist

Group Name: Date:


Name of the Students: Name of Instructor:

Universal Management EXCELLENT SATISFACTORY NEEDS


of Initial Presentation IMPROVEMENT
Primary Survey - BLS
Assessed patient
responsiveness
Checked airway patency
Assessed breathing
Assessed
circulation/pulse
If apneic, gave two
rescue breaths via BMV
Communication
If pulseless, called for
help (Code/Activate
Emergency Response
System)
Introduced oneself on
their respective role
(Team Leader etc.)
Initial
Management/Monitoring
If pulseless, commenced
Cardiopulmonary
Resuscitation (CPR)
Place backboard/cardiac
board under the patient
Attached ECG electrodes
Attached AED, if
available
Placed pulse oximeter
Attached BMV (>10L/min
if SaO2<93%)
Confirmed chest rise with
BMV
Rate of 100–120
compressions/minute
verified or corrected if
improper
Hand placement: midline,
lower half of sternum
verified or corrected if
improper
Compression depth 1.5–
2” verified or corrected if
improper.
Asked AMPLE (Allergies,
Medications, Past
Medical History, Last
Meal, Events leading to
Code Blue)
Intravascular Access
Checked existing IV
function or started IV if
absent
Gave IV fluid bolus if
hypotensive

Ventricular
Fibrillation
(VFIB)/Pulseless
Ventricular
Tachycardia
(VTACH)
Assessed rhythm,
pulse, and stability
(N/A if presenting
rhythm)
Stated diagnosis of
VFib/VTach with no
pulse
Continued CPR
until debrillator
attached
Declared all clear
prior to defib
Immediately
defibrillated @
150–200 J after
rhythm recognition
Resumed CPR
Rhythm and pulse
checked (<10 sec
pause)
Declared ‘all clear’
prior to defibrillation
Defibrillated at 200
J biphasic -
SHOCK 2
Gave Epi 1mg IV
Rhythm and pulse
checked (<10 sec
pause)
Declared ‘all clear’
prior to defibrillation
Defibrillated at 200
J biphasic -
SHOCK 3
Resumed CPR
PEA (Pulseless
Electrical Activity)
Assessed rhythm,
pulse, and stability.
Started/continued
CPR
Stated PEA as dx
Pulse & rhythm
check <10s
Resumed CPR
Gave epinephrine
1mg IV
Asystole
Assessed rhythm,
pulse, and stability.
Confirmed asystole
in 2 leads (Verified
placement)
Stated diagnosis of
asystole
Resumed CPR
Gave Epi 1mg IV
Sinus Rhythm
(SR)
Assessed rhythm,
pulse, and stability.
Confirmed Sinus
Rhythm in 2 leads
Stated diagnosis of
Sinus Rhythm
Checked the VS
including O2
saturation.
Ordered blood
works Post cardiac
arrest.
Declared that the
“COD” is over.
Transferred the
patient to the CCU
(if patient is in the
intensive care unit,
continue
monitoring).
Documented all the
care and
management that is
given to the patient.
(Adapted from Validation of a Detailed Scoring Checklist for Use During Advanced Cardiac Life
Support Certification, National Library of Medicine, PMC Aug. 1, 2013
([Link]

Preceptor’s Recommendations/Comments:
Grade:

__________________________
Name of Preceptor and Signature

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