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?

Agitated patients with dementia or delirium will pull at clothes, bed linens, IV lines, and tubes. I've seen this more times than I care to think about.

For a patient who is alert, basically oriented, not in acute distress, I have seen this in varying degrees, from simply picking at clothing or bed linens, to picking at their own skin, creating non-healing ulcers

In both instances, I associate this type of behavior with anxiety or discomfort.

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.

All the above, as well as: drug reaction to heavy narcs, or, in pain/discomfort and unable to verbalize that they are in pain/has something causing pain not needing narcs but needing IV site check, repositioning, etc. unable to verbalize.

Many of my Alzheimer's and dementia pts 'pick' as if they are picking lint off something. I've also seen it in pts who's health declined and they were heading for the "Celestial Discharge" and right before some of my patients started actively dying.

Specializes in Orthopedic, LTC, STR, Med-Surg, Tele.

I've seen it a couple of times - once in an old lady I gave Flexeril to, and an older male patient who got Ativan. They were 'plucking' at midair in their sleep.

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.

Specializes in Medical Oncology, Alzheimer/dementia.

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.

Specializes in Emergency & Trauma/Adult ICU.

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

Specializes in Medical-Surgical.

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.

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.

Specializes in ICU, Ortho, LTC, Hospice, Anesthesia.

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.

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.

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