The elementary school nurse has identified a problem requiring a secondary intervention. Which intervention should the nurse implement?

A) Smoking cessation:
Smoking cessation is a crucial preventive measure and is considered a primary prevention strategy to reduce the risk of developing smoking-related diseases. However, for a middle-aged client who already has health issues such as obesity or hypertension, secondary prevention focuses on early detection and management of conditions that have already developed or are at high risk of developing.

B) Compliance with antihypertensive and lipid-lowering agents:
While compliance with medication is essential for managing existing conditions such as hypertension or dyslipidemia, it is not a secondary prevention measure in itself. Secondary prevention is focused on screening and early detection of health issues before they progress further.

C) Blood pressure and lipid screening:
Blood pressure and lipid screening are appropriate secondary prevention measures for this client. Secondary prevention involves identifying and managing health conditions early to prevent progression or complications. Given the client’s smoking history, weight, and potential risk for cardiovascular issues, regular screening for blood pressure and lipid levels helps detect any developing issues early, allowing for timely intervention.

D) Increase physical activity and diet low in saturated fat:
Increasing physical activity and adopting a diet low in saturated fat are important lifestyle changes for overall health and primary prevention of chronic diseases. However, in the context of secondary prevention, where the focus is on monitoring and managing existing risk factors or health conditions, screening measures like blood pressure and lipid testing are more directly relevant.

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.