Student: Elementary-age student; identifying information omitted

Assignment: Dedicated one-to-one licensed nursing support

Proposed level: LPN working within scope and under the direction of the certified school RN

Primary daily needs: Frequent G-tube feedings, seizure monitoring, possible oral suctioning, respiratory observation, positioning, personal care coordination, and emergency readiness

The student has significant neurological, physical, respiratory, feeding, and communication needs. The student is dependent on adults for nutrition through a gastrostomy tube, safe positioning, mobility, monitoring, personal care, and communication of discomfort or changes in condition.

·        Complex seizure disorder with prescribed emergency rescue medication.

·        Quadriplegic cerebral palsy and global developmental delay.

·        Limited speech and communication related to neurological impairment.

·        G-tube dependence for nutrition and hydration.

·        Pulmonary hypertension, obstructive sleep apnea, and sleep-related hypoventilation.

·        History of vomiting with possible need for oral suctioning.

·        Additional cardiac, renal, and metabolic conditions that contribute to medical complexity.

 | Care responsibility | Expected frequency | What the LPN should expect | Arrival and baseline review | At arrival and as condition warrants | Assess general appearance, alertness, respiratory effort, secretion management, positioning, G-tube site, feeding tolerance history, seizure activity, and availability of medications, supplies, and emergency equipment.
| G-tube bolus feeding | Every 45-60 minutes as tolerated | Follow the current prescriber's order. The available order describes 60 mL of prescribed blended formula with 1 teaspoon of MCT oil and 60 mL of free water with each bolus. Confirm this regimen before assignment.
| Pre-feeding observation | Before every feeding | Position with head elevated 30-45 degrees unless otherwise ordered; inspect the G-tube site; observe for leakage, abdominal distention, belching, gas, loose stools, discomfort, pain, or signs of intolerance.
| During and after feeding | Each feeding and afterward | Administer slowly as ordered, stop or hold for discomfort or vomiting, flush with ordered water, maintain elevation for approximately 30 minutes when possible, clean equipment, and document response.
| Seizure monitoring | Continuous readiness; response as needed | Recognize the student's typical seizure presentation, time the event, protect from injury, position to support the airway, observe breathing and color, provide post-seizure care, and document and report the event.
| Emergency seizure medication | For a seizure meeting the current emergency threshold | The available order identifies intranasal diazepam for a seizure lasting longer than five minutes. Follow the current order and Emergency Action Plan; EMS is to be activated when emergency medication is administered.
| Vomiting / oral suctioning | As needed | Respond promptly to vomiting or choking risk, turn and position to protect the airway, stop feeding when applicable, assess respiratory status, and perform oral suctioning only as ordered and included in the RN-developed plan.
| Respiratory observation | Throughout the day and during events | Monitor for increased work of breathing, ineffective secretion clearance, color change, reduced responsiveness, choking, aspiration signs, or other departure from baseline.
| Positioning, mobility, and personal care | Throughout the day | Coordinate safe positioning, transfers, hygiene, toileting, and equipment needs with classroom staff while monitoring medical tolerance and skin/tube safety.
| Documentation and communication | After procedures and with any change | Document feedings, water, tolerance, vomiting, suctioning, seizures, medication, assessments, interventions, and communications. Notify the certified school RN, family, provider, or EMS according to the care plan.

·        Before the student arrives: review the day's health information, confirm orders and plans are accessible, check rescue medication and expiration date, prepare feeding and suction equipment, and verify backup/EMS procedures.

·        At arrival: complete and document a baseline observation and confirm whether the student had overnight seizures, vomiting, feeding intolerance, respiratory changes, medication changes, or other concerns.

·        Across the school day: remain available for nearly hourly feedings and post-feeding observation while continuously monitoring seizure, respiratory, positioning, and communication needs.

·        During instruction and activities: accompany or remain immediately available as required by the RN-developed plan; protect tubing and equipment and coordinate access without unnecessarily limiting participation.

·        Before dismissal: complete documentation, communicate significant information, secure medications and supplies, and transfer responsibility according to the transportation and parent handoff plan.