A patient with sickle cell anemia says they are planning a ski trip to a high-altitude area. The nurse assesses for the need for further instruction when the patient states:

• A. I will avoid iced drinks.
• B. I miss my beers in the afternoon.
• C. I walk every day instead of strenuous exercise.
• D. I am looking forward to my annual ski trip to Colorado.

Answer: (D)

High altitude reduces oxygen availability, which can trigger more sickling in people with sickle cell disease. That makes travel to a high-altitude environment a situation where careful planning and education are essential to prevent a crisis or serious complications.

The statement about looking forward to an annual ski trip to Colorado best signals a need for further instruction because it shows a plan to be in a high-altitude setting without demonstrated awareness of the necessary precautions. The nurse would discuss how to travel safely with SCD: stay well hydrated to reduce blood viscosity, avoid dehydration and extreme exertion, pace activities and acclimate gradually, monitor for early signs of a crisis (increasing pain, chest symptoms, fever), and seek medical advice before travel (and consider having a plan for emergencies, oxygen needs if prescribed, and a medical letter or arrangements with a hematologist).

The other comments don’t indicate a lack of preparedness for altitude-related risk: avoiding iced drinks isn’t a major risk signal, missing alcohol could even reduce dehydration risk, and walking daily instead of strenuous exercise reflects a generally safer approach for routine activity.