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?

Alzheimers you see this, and is the patient on a med that a dyskenisia is a side effect? That can happen with a number of medications. Which if the patient needs the med, a cogentin or benedryl can sometimes help. NOT giving medical advice, for learning purposes only. Research her meds.

Specializes in Pedi.

I've seen it once... the patient was delirious in acute ETOH withdrawal.

?magnesium def?

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.

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.

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.

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

Plucking, see my comments for medical explanation

+ Join the Discussion