Patient Picking At Clothing/Bed Linens

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 her exam was OK.

She was resting on her bed, but opened her eyes and talked to me and answered appropriately when I spoke to her. The only thing different was that she seemed distracted (for lack of better term), and kept moving her hands around like she was picking at her clothing and the bed linens.

When I called her daughter to update on mom's condition, the daughter mentioned that patient had been talking about having seen her brother.....the patient's brother that passed away 30 years ago. I didn't say it to the daughter, but know that shortly before death, many people see and speak to loved ones that have already died.

Thoughts? Is this picking behavior unusual? Wasn't even sure how to chart it, what would you say?

[Bouncyball]

I'm still a nursing student, but just had my death and dying and hospice lecture. Our instructor said that she frequently sees patients near death start picking at the sheets, clothes, or themselves. She said once pts start seeing dead relatives it is a sign of impending death.

[proud nurse, BSN, RN]

I worked for 6 years in LTC on an Alzheimer/dementia unit. I'm pretty sure it's called floccillation...might be wrong. Seen it many times, especially working the night shift. And usually in the patient in the dying stages.

[Altra, BSN, RN]

Agree with what's been said above: check for hypoxia, anxiety, pain ... or if the patient is simply *getting on the Jesus bus*.

[NursieNurseLPN, LPN]

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.

[maryray]

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.

[84RN]

jeannepaul said:

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.

[mustlovepoodles, RN]

sharonp30 said:

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]

Saw it lots when I worked on a geriatric med-surg floor. Sometimes with dementia (back when we called it organic brain syndrome), sometimes with tardive dyskensia, sometimes just because. To prevent patients from picking sores on themselves or irritating their finger tips (if it was really bad) we would place a square of shearling across their lap for them to pick at.

[Wise Woman RN]

I've seen it with patients with low sodium levels..

[Tmgdl]

Plucking, see my comments for medical explanation