The community health center has noticed a dramatic increase in influenza cases over prior years. The facility nurses have been charged with reviewing outcome data to determine if there is a trend in vaccination rates, and if a trend is noted, reasons for decline. An action plan will be developed to increase rates, if needed. The facility nursing team develops a plan to survey the community and facility records. Select all applicable action(s) that will facilitate gathering data for analysis.

A) Make a referral to have the scoliosis further evaluated:
Making a referral for further evaluation is the most important intervention. A noticeable unequal symmetry of the upper and lower back suggests the possibility of scoliosis, a condition that requires accurate diagnosis and assessment by a specialist. An orthopedic evaluation or consultation with a healthcare provider can provide a definitive diagnosis and guide appropriate management or treatment.

B) Measure the degree of the thoracic and lumbar curvature:
Measuring the degree of curvature can provide useful information about the severity of scoliosis but should be done by a healthcare professional specializing in scoliosis. Initial steps should focus on referring the student for a comprehensive evaluation, which will include assessing the degree of curvature along with other diagnostic procedures.

C) Ask about the student's ability to participate in sports:
While it is important to consider the student's ability to participate in sports, this is not the immediate priority. The primary concern should be obtaining a proper diagnosis and assessment of the potential scoliosis to determine if there are any limitations or necessary modifications in physical activities.

D) Review students' health record for a recent growth spurt:
Reviewing the health record for a recent growth spurt may provide context, as rapid growth can influence scoliosis development or progression. However, the most critical step is to refer the student for further evaluation to address the observed signs of scoliosis and determine the appropriate course of action.

A. Census data:
Census data provides demographic information about populations, such as age, sex, and ethnicity, but it does not typically provide detailed statistics on specific health outcomes like infant death rates.

B. Bureau of Vital Statistics:
The Bureau of Vital Statistics collects and maintains data on vital events such as births, deaths, marriages, and divorces. This resource would provide the most accurate and comprehensive data on infant mortality rates for comparison between cities and the state.

C. Disease registry:
Disease registries track specific diseases and conditions, but they are not typically used for gathering data on general statistics such as infant death rates. They are more focused on chronic or specific conditions.

D. Department of Health:
While the Department of Health can provide a wide range of health-related information and data, the Bureau of Vital Statistics is the specific resource for detailed and accurate mortality data. The Department of Health may use this data but does not typically maintain it directly.