A school nurse identifies 15 new students with positive tuberculin tests among the 500 at-risk students fested. Which is the rate per 1,000 with new positive tests?

1. A 12-year-old child with a history of asthma who is wheezing and reporting shortness of breath.

Rationale: The child with asthma who is wheezing and experiencing shortness of breath is the highest priority. Wheezing and shortness of breath are signs of a potentially severe asthma exacerbation, which can quickly become life-threatening if not addressed promptly. Immediate intervention is needed to ensure adequate oxygenation and prevent further respiratory distress.

2. A 7-year-old child who has type 1 diabetes mellitus and is experiencing extreme hunger and shakiness

Rationale: The child with type 1 diabetes mellitus who is experiencing extreme hunger and shakiness may be showing symptoms of hypoglycemia, which can also be potentially dangerous. While not as immediately life-threatening as severe respiratory distress, hypoglycemia needs to be addressed quickly to prevent complications such as loss of consciousness or seizures.

3. A 10-year-old child with bleeding lacerations on both knees after falling in gym class.

Rationale: The child with bleeding lacerations requires prompt care to manage the bleeding and prevent infection. However, this situation is less critical compared to the respiratory distress and hypoglycemia, which have more immediate implications for the child’s health.

4. A 5-year-old child who is crying uncontrollably because of an incontinent bowel episode.

Rationale: While the child’s distress and the need for clean-up are important, this situation is the least urgent in terms of immediate health risks compared to the other three cases. Addressing the child’s comfort and hygiene can follow after more critical needs are met.

A. Low income families living in cramped quarters: Hepatitis A is primarily spread through the fecal-oral route, often through contaminated food or water. Individuals living in overcrowded or unsanitary conditions are at a higher risk due to the increased likelihood of exposure to contaminated sources and poor hygiene practices. Thus, low-income families living in cramped quarters are particularly vulnerable to hepatitis A.

B. Sexually active persons with multiple partners: While hepatitis B and C are more commonly associated with sexual transmission, hepatitis A is less commonly spread through sexual activity. Hepatitis A transmission is more directly related to poor sanitation and hygiene rather than sexual behavior alone.

C. IV drug users who share needles: Intravenous drug users who share needles are at high risk for hepatitis B and C, not hepatitis A. Hepatitis A is not typically transmitted through blood but rather through contaminated food and water.

D. Those who have recently received a blood transfusion: Hepatitis A is not transmitted through blood transfusions. Hepatitis B and C are the types of hepatitis associated with blood transfusions. Hepatitis A is spread through ingestion of contaminated food or water.