Members are discussing the behavior of patients, particularly those with dementia or those near the end of life, who exhibit picking or plucking behaviors. This behavior is seen in various medical conditions, including delirium, dementia, brain tumors, and kidney failure, and can be associated with anxiety, discomfort, or impending death. Some members also mention seeing similar behaviors in patients with neurological conditions or after strokes. The discussion also touches on the challenges of caring for patients exhibiting these behaviors and the importance of considering hospice care for those nearing the end of life.
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?
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.
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.
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.
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.
jeannepaul, BSN
134 Posts
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.