An older client with pernicious anemia uses hot packs to loosen psoriatic plaques. The practical nurse (PN) who assists with the care twice weekly should refer which finding to the home health care charge nurse?

A. Brown spots on hands and arms: These are common age-related changes (lentigines) and are not an urgent concern related to hot pack use or psoriatic care. B. Areas of decreased pigmentation: Hypopigmentation can occur in psoriasis or with chronic skin changes, but it is not typically a sign of acute injury or complication from heat therapy. C. Erythema and edematous areas: Redness and swelling indicate possible skin irritation or burns from hot packs. These findings require prompt referral to the charge nurse for assessment and intervention to prevent further injury or infection. D. Yellow-white scales on the skin: These are characteristic of psoriatic plaques and are expected findings. They do not signal a complication from the heat therapy and do not require immediate referral.