A nurse is discharging a child who has sickle cell anemia after an acute crisis episode. Which of the following instructions should the nurse include in the teaching?

Choice A rationale Restricting outdoor play activity to only one hour per day is generally not indicated for children with sickle cell anemia, unless specific environmental triggers are present. While extreme temperatures or intense, prolonged exertion can sometimes precipitate a crisis, moderate physical activity is beneficial for circulation and overall health. Choice B rationale Applying cold compresses is contraindicated for pain management in sickle cell anemia. Cold temperatures cause vasoconstriction, which can exacerbate sickling of red blood cells and worsen pain by decreasing blood flow and oxygen delivery to tissues, potentially precipitating or intensifying a vaso-occlusive crisis. Warm compresses are preferred. Choice C rationale Adequate hydration is critical in preventing and managing sickle cell crises. Dehydration increases blood viscosity and promotes red blood cell sickling, leading to vaso-occlusive events. Offering fluids multiple times a day helps maintain good hydration, dilutes the blood, and reduces the likelihood of sickling. Choice D rationale Monitoring a child's temperature daily is important for detecting early signs of infection. Children with sickle cell anemia are immunocompromised due to splenic dysfunction (autosplenectomy) and are at increased risk for serious bacterial infections. Fever can be the initial indicator of a life-threatening infection, requiring prompt medical attention.