A patient who has severe refractory psoriasis on the face, neck, and extremities has quit a job as a bank teller and has withdrawn from all social activities. The patient tells the nurse, "I look like a monster. I can't think of a single reason to keep living." The most appropriate response by the nurse at this time is

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The patient with visible skin lesions without severe systemic effects is at high risk for social and emotional problems. Referrals to resources such as counselors, psychiatrists, and support groups should be included in the plan of care. Although teaching about cosmetic use and listening further to the patient may be included in the plan of care, the patient's comments indicate an emotional crisis, so referral to a mental health provider is most appropriate. Because the patient's appearance has caused withdrawal from social activities, asking the patient about helping in community projects is not appropriate.

A Patient Who Has Severe Refractory Psoriasis on the Face