Patient Picking at clothing/bed linens - page 3

by 84RN 14,150 Views | 31 Comments

Has anyone ever seen this? I work in home health and have a patient with multiple serious health conditions. During a visit the other day, she seemed normal clinically---all VS normal for her, her O2 Sat and everything else on... Read More


  1. 1
    Agree with what's been said above: check for hypoxia, anxiety, pain ... or if the patient is simply *getting on the Jesus bus*.
    ~*Stargazer*~ likes this.
  2. 0
    I've only worked with a few residents who were actively dying but all of them had the "picking" symptom, they would pick at things on their clothing, their skin, even my skin when I held their hands and whatnot. It wasn't always immediate to their passing, one of my residents started this a few months ago and just passed a couple nights ago (). Very weird.
  3. 1
    My father started doing this when his kidneys were failing. It would get worse when he was getting dialysis and/or if he had electrolyte imbalances.
    Wise Woman RN likes this.
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    As a former certified hospice and palliative nurse, this "picking" behavior (the official term is carphologia) is commonly seen in delirious patients near the end of life. Based on this patient's condition, plus talking with people who have been long dead, this may be just a sign of impending death.
    KeyMaster likes this.
  5. 2
    I found these:

    floccillation
    /floc·cil·la·tion/ (flok″sĭ-la´shun) the aimless picking at bedclothes by a patient with delirium, dementia, fever, or exhaustion.
    Dorland's Medical Dictionary for Health Consumers. © 2007 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

    carphology

    (kăr-fō-lō′jē-ă)
    [Pronunciation]
    (-fŏl′ō-jē)
    [Gr. karphos, dry twig, + legein, to pluck]

    Involuntary picking at bedclothes, seen esp. in febrile delirium.

    SYN: floccillation
    AnonRNC and KeyMaster like this.
  6. 1
    We see it all the time in Hospice, sometimes they will just put their hands in the air, pretend they are eating something, or other things with the hands. Also talking to and about people who have already passed, and about 95% of the pt's, if they can communicate will see little children, regardless of the diagnosis, they will talk about children, babies. It is not scary to them, but they all seem to see the same thing.

    A long time ago they used to say it was caused by lack of oxygen, but when they checked, the 02 sats are fine. Some say it's because of the narcotics, but I see the same thing with people who are not taking any medication.

    People with dementia can "pick" for years, but when combined with other symptoms, we can tell when it is getting to the end of their life. It may be time for a hospice consult.
    IowaKaren likes this.
  7. 0
    My dad did this the last few days of his life. He did not have dementia. He would reach over from his chair in the hospital room and pick/grab at his bed sheets.
  8. 0
    Quote from jeannepaul
    We see it all the time in Hospice, sometimes they will just put their hands in the air, pretend they are eating something, or other things with the hands. Also talking to and about people who have already passed, and about 95% of the pt's, if they can communicate will see little children, regardless of the diagnosis, they will talk about children, babies. It is not scary to them, but they all seem to see the same thing.

    A long time ago they used to say it was caused by lack of oxygen, but when they checked, the 02 sats are fine. Some say it's because of the narcotics, but I see the same thing with people who are not taking any medication.

    People with dementia can "pick" for years, but when combined with other symptoms, we can tell when it is getting to the end of their life. It may be time for a hospice consult.

    I'm working up my nerve to suggest hospice to the daughter, but know she's not ready to hear it right now. She has taken her mom (and dad, also our patient) to the ER repeatedly for anything and everything, and each time they've been admitted, they are full codes. I recently suggested she consider an ALF or skilled nursing facility for her parents, and she ranted and yelled for 15 min on the phone to me for that one. Right now, the parents are in a condo, and have 24 hr aides, but they have a lot of turnover (she won't use an agency, finds her own, has even used Craigslist) and one person assisting these two very debilitated seniors is just not enough. The lifting alone would break my back, and several times after one of them fell or slipped down when transferring, the HHA has had to call EMS to help get them back to bed. Both parents have had PT and OT, but have pretty much reached max potential.
  9. 0
    People who are in the pre-imminent to imminent stages of dying often exhibit that type of restless behavior as well as seeing and speaking to deceased loved ones.

    Does her overall level of decline support the thought that she may be nearing death? Is she still swallowing? How is her peripheral perfusion? What is her functional status?
    Last edit by tewdles on Dec 12, '12 : Reason: spelling
  10. 1
    Quote from sharonp30
    My father in law had brain cancer. In the end, he would sit in a chair and start moving his hands as if he were wrapping string around his hands. It was really amazing to watch. He did this for about a week or two before he passed away.
    My grandfather did this in the days leading up to his death. He had been completely cognitively normal up to the last week. By then he was only semi-conscious. He spent hours raising his hands in the air and making twisting motions, like he was turning something in his hand. My mom said that when he was a young man working int he shipyard, his job was checking the boiler pressures which required him to twist the valves on and off. So I think he was just comforting himeself by remembering things from another time.
    KeyMaster likes this.


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