For three weeks, my 93 year old Mom’s healthcare team misread her X-ray and misdiagnosed two fractures to her hand. This resulted in it being horribly swollen and painful. The ER doctor who finally recognized what was wrong prescribed Tylenol and a splint that will keep her hand raised.
However, due to her dementia and combativeness Mom has repeatedly fought to remove the splint and now refuses to take the Tylenol until the pain gets intolerable.
Her healthcare team has recommended medication to calm her. The problem is that in the past this medication has sedated her to the point where she won’t eat or drink.
I am frustrated! Has anyone else had experience with this? What did you do?
What is worse, unhealed fracture and mom not being able to use hand? Or a couple of weeks of sedation and less than adequate nutrition? How would a temporary feeding tube be tolerated during that time?
Have you read Atul Gawande's On Being Mortal?
Tylenol is better at preventing or suppressing pain than it is at relieving it once it's established. So if it's been prescribed at 1g x 4 doses daily, you'll find it works best if you take it just so - never less than four hours between doses, and never exceed four doses in twenty four hours. It is a very safe drug, but one drawback is that you don't have to take much more than the recommended amount to overdose; and then it's not safe, not at all.
You can get it in syrup formulations, might that be more acceptable to her?
I did, a little while back, meet an older lady who had refused to have her broken ankle set - no, don't feel sorry for her, she was not frightened or confused or too frail for surgery, she objected to the surgeon for reasons I'm embarrassed even to type and her daughter was mortified about. So, on that point at least, an idiot. Anyway; this had happened some years before I met her, and her ankle was an extremely peculiar shape, but the ankle was functional and not painful.
So the point is that it won't necessarily be the end of the world, or even the end of a functioning hand, if your mother doesn't wear the splint. Pain? - well, it's her hand. If the splint relieves the pain enough, she'll allow it to be fitted; keep offering, but allow her to refuse or to remove it.
I've no idea whether this would be justifiable or even possible clinically, but you could I suppose ask if anyone would be prepared to set her hand in a cast, rather than a splint, and see if that suits her better. As long as she doesn't thump anyone with it.
Have they said how long it might take to heal? I'm not convinced by the ethics of sedating your patient to make her compliant with your treatment. Pretty sure you're supposed at least to try to adapt your treatment to suit your patient, instead.
If it's (b), I'd add a few ribbons, perhaps some small artificial flowers, so that every time she looks at the cast she sees something lovely.
I know that casts can be inconvenient, though, and that's probably what irritates her the most.
As to removing the splint can her other hand be placed in a mitten so that it is more difficult to remove the splint.
Or can the arm with the splint on it be left UNDER the shirt that she wears. This would also make it very difficult for her to remove the splint.
She wouid remove the boot and when fussed at by her daughter she would throw it at her.
She also threw it at her dog when he barked. Somehow the ankle seemed to heal well even with the boot flying through the air instead of on her ankle.
She may be seeing the splint & blaming that for the pain.
Hopefully when the pain gets under control, she may leave the splint in place?
Best of luck.