A nurse is providing discharge teaching to a client who is recovering from a sickle cell crisis. Which of the following instructions should the include?

D. A thrill is a palpable vibration or buzzing sensation felt over the graft site, caused by turbulent blood flow. In the context of an arteriovenous graft, a palpable thrill is typically considered a positive finding, indicating adequate circulation through the graft. It suggests that blood is flowing smoothly from the arterial to the venous side of the graft.
A. The presence of a bruit is typically considered a positive finding, indicating adequate blood flow through the graft. Therefore, the absence of a bruit may indicate inadequate circulation or a potential complication such as graft occlusion or stenosis.
B. Normal blood pressure is not a specific indicator of the adequacy of circulation through an arteriovenous graft.
C. A dilated appearance of the graft may suggest venous hypertension or increased pressure within the graft. While this could indicate adequate blood flow, it may also suggest problems such as venous stenosis or thrombosis, which can impede circulation through the graft.

D. Extreme temperatures, both hot and cold, can trigger sickle cell crises in individuals with sickle cell disease. Cold temperatures can cause vasoconstriction and increase the risk of sickling of red blood cells, while hot temperatures can lead to dehydration. Therefore, clients with sickle cell disease should avoid exposure to extreme temperatures and take precautions to maintain a comfortable environment, especially during hot summer months and cold winter seasons.
A. Clients with sickle cell disease are at increased risk of developing complications from influenza (flu) infections. Therefore, it is highly recommended that clients with sickle cell disease receive an annual flu vaccination to reduce their risk of contracting the flu and its associated complications.
B. Hydration is crucial for individuals with sickle cell disease as it helps prevent dehydration and reduces the risk of sickling of red blood cells, which can trigger a sickle cell crisis.
C. Alcohol can exacerbate dehydration and increase the risk of vaso-occlusive crises in individuals with sickle cell disease.