A nurse is reinforcing discharge teaching to a client who had a sickle cell crisis. Which of the following health promotion strategies should be included in the teaching? (Select All that Apply.)

A. Frequent handwashing: Sickle cell patients are often functionally asplenic (the spleen is damaged), making them highly susceptible to infection. Infection is a leading trigger for sickle cell crisis. B. Avoiding the annual flu vaccine: Sickle cell patients should receive all recommended vaccines to prevent infections that could trigger a crisis. C. Taking an iron supplement daily: Iron is usually not recommended because these patients often have iron overload from frequent blood transfusions. D. Visiting the eye doctor annually: Sickle cell disease can cause proliferative retinopathy due to vaso-occlusion of the small vessels in the eye, which can lead to blindness. E. Joining a support group: Chronic illness takes a significant toll on mental health; support groups provide coping strategies and community.