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?
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.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
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?
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.
Specializes in OR, CVOR, Clinical Education, Informatic.
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.
This is called plucking. It is a sign of kidney failure. Acid in urine is entering the blood stream which causes them to see something as they have open eyes but looking up or away. I forget the actual medical term. This comes with 2 other signs that the end is near. It can also be painful. Ativan does help to keep patient calm. We call 2 other signs for lack of better words, the "O" and the "Q". O is when patient has open mouth, shape of O and breathing sounds like they are snoring. The other is "Q". The mouth is open but with the tounge out to the side. The plucking can come and go and at times having ativan on hand will help to slow or stop "plucking".
Sorry about my spelling folks, long week with a friend who is near her end and having these symptoms now. Please ask a doctor to explain plucking to get proper medical term and make sure i am explaing it all correctly. This is the basic explanation i reveived from a retired dr. Just today.
"Picking" is not always in relation to hospice patients. I work on a Neuro Critical Care unit and many patients (who fully recover), exhibit the picking behaviors. Usually it's a hyper focus on one item, such as a SAT PROBE, straightening the bed linens, or pulling at the nape of their gown. It's related most often to frontal stroke injury, and is common within the first week or so after a stroke or re-bleed.
Does she have Alzheimers or any sort of dementia? I've seen it when a person with dementia didn't recognize what was on them (the shirt, linens) and kept picking at it. And there are some psychiatric issues where people will misinterpret what they are seeing, so could be that too....Could be a host of things really! I would just chart it as "Picking at clothing and linen continuously" I think.
84RN said:
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?
This patient does have some dementia, but this is the first time I've ever seen this behavior, and I've had her as a patient on and off for almost a year now.
She's definitely declined in the last month, and has been hospitalized several times for different problems.
To loriangel - I've seen this behavior many of times with the dementia pts, but never associated it as a S&S. Am always learning something new here. TY
Anna Flaxis, BSN, RN
1 Article; 2,816 Posts
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.