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?
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.Quote from 84RNHas 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?

I have heard "picking" described as a archtypical end-of-life behavior and have seen it on occasion in pts that were getting close (ie-weeks to days).

Yes I have seen the picking motion in patients with dmentia, most often Lewy Body.They will also make a motion that is like picking threads off of things.

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.

The picking will be part of the decline.

I've seen this mostly in dementia patients.

I see this all the time in delirious pts. Just can't keep those johnnies on them!!

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

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.

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

Besides dementia pts, I've seen something similar in a pt that had what I consider kind of an absence seizure in the chiro office I worked in. The treatment table uses hydraulics to raise vertically for the pt to step on. When it was raised up so she could turn to her back, she just stood on the platform with a blank look on her face, mumbling to herself & picking at the towel that covered the table. It lasted for probably 2-3 minutes while the doc & I looked at each other like "what the heck?" Pt didn't recall anything when she "came to". We immediately set her up for a neuro consult & turns out she had a brain tumor. She had come to us following an MVA which she had caused & seems that she probably had one of these "episodes" at the time of the accident.

?magnesium def?