A 14-year-old male child with sickle cell anemia is being discharged after treatment for a crisis. Which instructions for avoiding future crises should the nurse provide the child and family? Select the 3 that apply.

Rationale: A. Drink plenty of fluids: Adequate hydration helps prevent sickling of red blood cells by reducing blood viscosity, which lowers the risk of vaso-occlusive crises. Encouraging fluid intake is essential in crisis prevention and maintaining overall health. B. Restrict any physical activities: Completely restricting physical activity is not necessary and can negatively impact the child’s physical and emotional well-being. Moderate, supervised activity is usually encouraged, with avoidance of extreme exertion or dehydration. C. Report a fever to an adult immediately: Fever can signal infection, which is a common trigger for sickle cell crises. Early reporting ensures prompt medical evaluation and treatment to prevent complications. D. Wash hands before meals and after playing: Proper hand hygiene reduces the risk of infections, which can precipitate sickle cell crises. Teaching good hygiene practices is critical for infection prevention. E. Use cold pack to relieve joint pain: Cold can cause vasoconstriction and worsen sickling; therefore, warm compresses are preferred to relieve joint pain. Using cold packs is contraindicated in managing sickle cell pain crises.