1. Joint PREP Class Shoulder Replacement
T. Andrew Israel, MD
Luther Midelfort Orthopaedic & Sports Medicine Center

2. Goals for you and your family
Recognize shoulder replacement is a reliable operation to improve quality of life
Describe what to expect of the shoulder replacement procedure.
Discuss the risks of shoulder replacement surgery.

3. Goals of Your Shoulder Replacement
Improve your quality of life by:
Relieve your pain
Improved motion
Improved strength
Better function

4. Shoulder Joint Replacement Indications
Bone on bone osteoarthritis
Intact rotator cuff tendons

5. Shoulder Arthritis
Loss of cartilage leads to narrowing of the joint space

6. Shoulder Arthritis
As the cartilage wears, bone spurs form and the shoulder becomes stiff

7. Surgical Technique of Total Shoulder Replacement
Replaces the worn bony surfaces with metal ball and plastic socket (glenoid)
Restores shoulder motion and stability

8. Implant Materials A plastic socket A Metal ball attached to a stem
-Non-cemented press fit into the
humerus or
- Bone cement is used to cement
the stem into the humerus.

9. Implant Materials A plastic socket is cemented into the glenoid.
A metal ball and stem goes down into the humerus.

10. Hemiarthroplasty A metal ball and stem goes down into the humerus.
No plastic socket is placed.

11. Reverse Total Shoulder Indications
Completely torn rotator cuff with severe arthritis
Complex fractures
Previous failed shoulder replacement

12. REVERSE TOTAL SHOULDER
Socket and ball are reversed
- Humeral head (ball)
becomes the
socket
- Glenoid (socket)
becomes the ball

13. Surgical Technique Incision
The incision is made in the front of the shoulder
Your surgeon will make the incision long enough to see the joint area
Your surgeon will use techniques to spare muscle
Surgical techniques continue to improve as technology advances

14. Day of Surgery
Your surgeon will meet you in SurgiCenter to initial your shoulder and answer final questions.
Family can wait with you in SurgiCenter.
You will go to the Operating Room (OR) Surgery lasts 2 hours.
You will then go to the recovery room for 1-2 hours.

15. After Surgery in the Hospital
Physical & Occupational Therapy is critical for a good outcome
Therapy starts the day after surgery
- Wear an arm sling immobilizer full time for 4 weeks
- No forceful contraction of muscles such as pushing up out of chair or bed.
- Follow the exercise program set up for you 4-5 times a day for 4-6 weeks.

16. Shoulder precautions
Do not overdo it! Early overuse may result in severe limitations of motion
Do not lift anything heavier than a glass of water for the first 6 weeks
Do not participate in contact sports or any repetitive heavy lifting after your shoulder replacement.
Avoid placing your arm in any extreme position for the first 6 weeks

17. Other Doctors in the hospital
Additional Doctors take care of non-orthopedic issues (such as high blood pressure or diabetes).
If you have an Internal Medicine doctor here, they will see you after surgery.
If your regular doctor does not see patients in the hospital, a Hospitalist will see you after surgery.
If you are not getting a medication you think you should, please ask.

18. Blood Clot Prevention
Enteric coated aspirin 325 mg twice a day while in hospital to prevent blood clots. Continue at home for 3 weeks.
TED hose worn for 3 weeks after surgery, you may remove these at night.
SCDs (calf squeezers) are on in the hospital whenever you are in bed.
Exercising your legs and being up and walking promotes blood flow.

19. Risks of Surgery Anesthetic Complications
Anesthesia providers meet with you the day of surgery.
They discuss anesthetic options including nerve blocks for postoperative pain relief.
Nausea and vomiting are common but more serious side effects or complications may occur.
Please tell the anesthesia provider of any past experience with anesthesia.

20. Risks of Surgery Blood Clots
Lower risk for blood clots with total shoulder replacement
Clots can go to the lungs and be fatal
Your risk is reduced to <1% if treated with medication (aspirin) and TED hose
Being active and walking helps to prevent blood clots

21. Risks of Surgery Infection
You will get antibiotics at the time of surgery and for 24 hours after surgery.
Surgeons, assistants and scrub techs wear “spacesuits”.
Using all precautions, risk of infection is ~1%.
Infection may occur months or years after surgery.
Infection may mean removal of your implants.

22. “ Spacesuits worn during surgery”

23. Risks of Surgery Blood loss
Bony surfaces bleed during surgery.
There may be some bleeding after surgery.
Your surgeon may use a drain in the shoulder
Your blood count will be checked each morning after surgery.
If you have symptoms from a low blood count, you may need a blood transfusion.

24. Risks of Surgery Medical Complications
Surgery is a stress to your body.
Heart and lung problems, stroke, stomach problems, constipation - all may occur.
A physical with your regular doctor and an EKG are required before surgery.
Despite precautions, unforeseen medical complications may still occur.

25. Risks of Surgery Dislocation
This is an artificial joint and may slip out of joint.
If it does dislocate, this often requires a trip to the hospital to have the shoulder put back in place.
You may be required to wear a brace if it dislocates.
Multiple dislocations may require revision surgery to fix the problem.

26. Risks of Surgery Need for Revision
We encourage patients to wait as long as possible before replacement.
Implants wear with time..
Wear rate is about 1% a year
Revision surgery may involve changing the plastic or changing one or all metal parts.
Revision surgery is more challenging with a more difficult recovery.

27. Recovery time 3-4 months: ‘normal’ activity
6 months: ‘normal’ endurance
12 months: maximal recovery
Focus on exercises for movement and then strength
Getting back to work is individual- check with your surgeon

28. Summary
Shoulder replacement is a reliable operation to improve quality of life with less pain, improved motion, strength and better function.
As with any operation, there are associated risks.
All of the precautions we take are to minimize risk and to provide for a “routine” operation

29. Patient Resource and Education Program
Joint PREP Class
Patient Resource and Education Program
Welcome to the nurse presentation of the patient resource and education program, for the patient undergoing total shoulder replacement.
I am ________(1st name) from the Orthopedic center.
There is a copy of the slide presentation in your folders for you to follow along with and to take notes if you would like.
There is also a space for notes in the back of the Mayo total joint booklet in your folder. Talk with your surgeon or his nurse about any questions or concerns you may have at your next scheduled visit. You may also call them with the questions.

30. Goals for you and your family
Discuss steps to take to get ready for the surgical procedure
Discuss what to expect of the surgical experience
Recognize why it is important for you to participate in your plan of care
Read slide bullets

31. Plan Ahead Appointments:
Your regular doctor for pre-surgery;
Blood work, EKG, Physical exam, discuss
medications
Your surgeon for final discussion and update
Stop smoking – talk to your regular doctor to get help
Call your surgeon if you get a fever, cold, infection or rash before your surgery date
Read slide.
Your primary care doctor will examine you to make sure it is safe for you to have surgery.
He may have you get fasting blood tests along with an EKG and other tests.
Your surgeon will see you back within 1 week of your surgery for a pre-operative examination to prepare you for the surgery.
There is a stop smoking brochure in your folder for more information.

32. Plan Ahead Plan for your return home
Identify who will take care of you after surgery; Plan for about 2 weeks
Identify who will assist you with shoulder exercises for 4-6 weeks
Practice daily activities not using the arm affected by surgery
Recovery is a gradual process and will take time after surgery.
Plan for your return home before you enter the hospital.
Identify who will take care of you after surgery. Plan for about 2 weeks. This is 24 hours every day of the week.
If you do not have someone who is able to care for you after surgery social services will discuss options with you.
Ask your spouse, children or friends if they can assist you with shoulder exercises for four to eight weeks after leaving the hospital.
Before surgery it may be helpful to practice daily activities not using your arm that will be affected by surgery. Anticipate a temporary change in your activity.

33. Plan Ahead (cont)
Simplify meals. Plan for 2 weeks of easy or no preparation meals
Pick up throw rugs and other hazards that may cause you to trip.
Place frequently used items in convenient locations…not too high or not too low
Any planned dental work should be finished about 2 weeks before your surgery date
Simplify meals. Plan for 2 weeks of easy or no preparation meals.
Pick up throw rugs or any other item that might cause you to trip after surgery.
Rearrange your kitchen so that often used utensils are easily accessed.
Finish any planned dental work at least 2 weeks before your surgery date.
Have your teeth in healthy condition. Bacteria in your mouth may enter your bloodstream and cause infection in the new joint If you have current work being done plan to finish before your surgery.

34. What to bring to the hospital
Loose comfortable clothing to wear home
Non skid comfortable shoes
Personal items: toiletries, books etc.
Medication list, inhalers, C-PAP mask
Prepaid long distance calling card (optional) Cell phones are not allowed to be used in the patient rooms
Loose comfortable Clothing: Jogging suit or larger button down the front shirt and pants that are easy to put on. (elaborate on position of arm for clothing- front closing bra or strapless)
Non Skid Comfortable shoes.
Personal items; toiletries like a comb, tooth brush and toothpaste, books, magazines
Medication list, inhalers, C-PAP mask
Prepaid long distance calling cards (optional) Cell phones not allowed to be used in the patient rooms. If you want to use a cell phone, ask the nurse where you can use the cell phones in the hospital.
Your Total shoulder Replacement information folder from this presentation.We will be using information from this folder during your hospital stay.

35. What not to bring to the hospital
Valuables/Jewelry
Credit cards, check book or large sums of money
Your medications (except inhalers)
-All Valuables/jewelry, even your wedding band if it comes off easily
-Credit Cards, check book or large sums of money
-Your medications- except inhalers

36. The day before surgery Review your medications
A SurgiCenter nurse will call you to:
Review your medications
Tell you what medications to take and not take the day of surgery
Review eating, drinking and smoking restrictions
Give hygiene instructions
Tell you what time to arrive at Luther Hospital
A SurgiCenter nurse will call you to:
Review your medications
Tell you what medications to take and not take the day of surgery
Review your eating, drinking and smoking restrictions
Nothing to eat, chew or smoke after midnight. No mints, hard candy or chewing gum
Your surgery may be delayed if you eat anything after midnight
May have clear liquids up to 2 hours prior to the time of surgery:
Water
Clear juices without pulp such as apple juice,
Clear broth,
Clear Jello,
Black coffee or tea,
Popsicles
Give hygiene instructions
Take a bath or shower the evening before or the morning of surgery.
Shampoo hair - it may be a while before able to do this after surgery.
Tell you what time to arrive at Luther hospital

37. Day of surgery Take medications at home as instructed Check in at
Luther Hospital
Registration Desk
Read Slide

38. Day of Surgery (continued)
You will be taken to the SurgiCenter
You will be asked your name and date of birth by everyone who has contact with you – this is done for your safety
Family and Friends are welcome. Try to limit to 2 people on day of surgery
Read Slide
Family/friends
Will be allowed to stay with you until you are taken to surgery.

39. SurgiCenter
Nursing admission in the SurgiCenter- We will ask you many questions and get you ready for your surgery
Leg squeezers
and TED hose applied
Anesthesia visit
Surgeon visit
Nursing admission in the SurgiCenter- We will ask you many questions and get you ready for your surgery
The nurse will put TED hose and SCDs (Sequential Compression Devices) leg squeezers on your legs
in the SurgiCenter
If you do have jewelry, remove and give to your family/friend.
Dentures, glasses and hearing aids may stay in place until you are taken to surgery.
Anesthesia staff will:
Discuss the type of anesthesia available for your procedure
Perform a brief examination
Start IV
Surgeon will:
Review the consent for your procedure and will sign your surgical site
Answer your last minute questions.

40. Leg Squeezers – SCDs
This is a picture of the leg squeezers

41. Going to the Operating Room
The Surgery RN will take you to the operating room
Family/Friends
Will be directed to the main lobby Family Lounge
They should register with the volunteer and will be given a beeper and contacted when the surgery is finished

42. Operating Room (OR) Monitors Anesthesia Surgical scrub Foley catheter
Staff will communicate to your family if the surgery is longer than 2-3 hours
Staff will hook you up to monitors .
Anesthesia will be given to you
Once you are asleep:
An antibacterial scrub is done to your surgical site; this may leave your skin with a bluish or brownish color that eventually washes off.
A catheter will be placed in your bladder
If the surgery is taking longer than 2 hours and they do not expected to finish soon, the Operating Room staff will try to call your family in the Family Lounge to let them know of the change in time.

43. Recovery Room/Post Anesthesia Care Unit (PACU)
Your nausea and pain are managed as you awaken
When you are ready, you will be transferred to a hospital room
Read slide:
After surgery you will be moved to the post anesthesia Care Unit PACU. Your relatives will be told when you are in PACU.
The most important functions of the PACU is to manage pain and nausea as you awaken from anesthesia.
When you are ready and nausea and pain are controlled (not eliminated),
you will be brought to your hospital room.

44. Arrival in your Hospital Room
You will have…
Oxygen
An IV
Your affected arm will be in a shoulder immobilizer after surgery
(May) have a foley catheter
A pulse oximeter – a device that fits on your finger to measure blood oxygen level
Read slide
You will be encouraged to cough and deep breathe frequently for the first few days after surgery
Respiratory therapy will evaluate your breathing needs.
(Pulse Oximeter is on next slide)

45. Pulse Oximeter
This is a picture of the pulse oximeter monitoring your oxygen level

46. Arrival in your Hospital Room (continued)
We will check on you, take your vital signs
You will be able to start drinking and eating when ready
Activity as you tolerate
Help you with control of pain and nausea.
When settled in your room, the nurse will
listen to your heart and lungs
check color, movement, and feeling in your surgical arm
tell you about your room and equipment used for your care.
Nutrition - Sips of water and/or ice chips --- then clear liquids if not nauseated progressing to regular foods
Activity:
May be up and around as tolerated as your doctor orders Do not get up by yourself ASK for Help!
We will continue to help you with control of pain and nausea

47. Pain Management
It is normal to feel pain or discomfort after surgery. Your pain may not be totally relieved but pain medication can be given to make you more comfortable. Read slide
You may begin to take your pain pills by mouth when you are able to drink fluids.
Ask your nurse for pain medicine before your pain becomes too intense
While you have an IV in you may have a Pain pump. This allows you to safely give yourself pain medication through your IV. Only the patient should push the button for pain medication.

48. After Shoulder Surgery
The nurse will check your bandage on your shoulder
Report any soreness, numbness or tingling in your arm or fingers to the nurse
Ice will be applied to your shoulder to reduce pain and swelling
Read slide.
Tell the nurse if any irritation occurs under your immobilizer . It is important to keep your arm supported to reduce any tension in the area of your operation.
Ice will be applied to your shoulder to help reduce swelling and discomfort around your incision.

49. You are a Partner in your care!
Post operative day
You will have….
Blood work
Medication
For pain control
Aspirin 325 mg for blood thinning to prevent blood clots
Activity – Occupational and/or Physical Therapy
You are a Partner in your care!
Blood work - Blood will be drawn
Medication for Pain Control – Continue using pain scale to rate pain Anticoagulation or blood thinning with a full strength aspirin
Catheter and drain will be removed if present
Activity
Physical therapists and Occupational therapist will begin working with you
Call for assistance/Do not get up by yourself!
White Board
Plans for each day in the hospital will be on a white board in your room so you know what to expect each day. It will also be used as a communication tool for the nursing staff, Physical Therapy, Occupational Therapy and you and your family.
About ½ of the people having total shoulder replacement will go home on the day after surgery. !/2 will go home the 2nd day after surgery.

50. Discharge Planning You will be discharged home from the hospital when:
Your medical condition is stable
You are able to manage safely at home with assistance
You are able to do your exercises safely
Your pain is under acceptable control
About half the patients go home on day one and the other half go home on day two.
Read slide.

51. Post operative day/Discharge day
The person who will be taking care of you after you go home needs to come to the hospital to learn about:
The person who will be taking care of you after you go home needs to come to the hospital for about 2 hours to learn:
Safety in your home
Activity and exercises for home from Physical and Occupational Therapy
When and how to use your immobilizer or sling
No lifting or holding weight until given permission by your surgeon
No heavy lifting as defined by your surgeon for the rest of your life
You should not lie directly on the surgical shoulder
You may have problems with constipation that can occur as a side effect of pain medications and as a result of decrased activity. Eat high fiber foods such as fresh fruits/vegetables and whole grains and drink 6-8 glasses of water daily unless instructed otherwise. You may need a stool softener.
Safety
Exercises – Therapy
When and how to use shoulder immobilizer, sling
Lifting restrictions

52. Day of Discharge cont’
Prepare for discharge to home or transitional care
Receive discharge instructions for:
Incision care/bathing instructions to keep incision clean and dry
Icing and how to keep swelling down
How to take pain medications correctly
Continuing aspirin 325 mg at home for blood thinning for 3 weeks
Wearing TED hose for 3 weeks
When to contact your Surgeon
Day of Discharge Prepare for discharge to home or transitional care unit.
The person who will be taking care of you after you go home also will learn about and get discharge instructions for:
Discharge Instructions - Staff will go over discharge instructions
Incision care: we will provide you with a kit to take home with all the supplies you will need. Ask for this if you do not get it.(Show Kit)
Applying ice to your shoulder may provide added comfort as well as help keep the swelling down.
Medications: You will be given a list of medications you will take at home
You may want to take a pain pill at each meal (to prepare for therapy exercises ) and at bedtime
You will be taking an aspirin 325 mg for 3 weeks at home for blood thinning to prevent blood clots. Being up, walking and being active at home will also help prevent blood clots. After 3 weeks you will go back to doing whatever you did prior to surgery i.e. baby/low dose ASA of nothing.
Also to prevent blood clots you will be encouraged to wear your TED hose for 3 weeks.
You will be instructed of when and how to contact your surgeon for concerns

53. To control swelling and pain at home
Apply ice to your shoulder after exercises (do not apply heating pad) for 4-6 weeks as directed
Pain medication as directed especially before exercises
Physical therapy/exercises as directed
Elevate and support your hand and arm on pillows above the level of the heart when at rest
You may experience shoulder discomfort and swelling for several weeks following surgery. use ice on your shoulder AFTER exercise, Use the pain medication as instructed to help you complete your exercises effectively and increase your activity.
Support your arm on pillows so the swelling in your hand and arm can flow back to the body by gravity. Do this when you are sitting or lying in bed.
Many people are most comfortable sleeping in a recliner for a few weeks.

54. After Discharge
A person to care for you will need to be available 24 hours a day to:
assist you at home the first two weeks
drive you to appointments
encourage you in your home exercise program
Change your incision dressing every day
Wear the immobilizer sling for 4 weeks, according to your surgeon’s directions
Read slide above…

55. Bathing
1. You may shower when your incision is dry (no drainage) Support your arm as directed by therapy
2. Place a plastic barrier over the incision, taped in place, prior to showering
3. Wash under arm, dry thoroughly and place dry padding to absorb moisture
4. Place a new dressing on the incision after shower
You may shower as soon as your incision is dry, with no drainage on your dressing.
Place a plastic barrier over the incision taped in place to prevent water on the incision.
Wash under arm, dry thoroughly and place a dry padding to absorb moisture under the arm.
Pat the incision area a dry and then remove the plastic barrier. Place a new dressing on the incision from your dressing packet.
Do not submerge the incision in a bathtub, pool, hot tub, etc, until the incision is completely healed

56. Driving
No driving. Talk with your surgeon about when you will be allowed to drive again
After permission you must :
Be off narcotic pain medicines to drive
Able to sit in car comfortably
Drive in a safe area
Read slide Being able to use blinker, shift lever. Do not rush back into driving.

57. A Follow-Up Appointment with your surgeon will be made 10-14 days after surgery
At your appointment:
- X-ray will be done of your shoulder
- Your stitches will be removed
- We will give you care instructions about your: incision, bathing, exercises, and a handout titled ‘Joint Replacement- Dental Procedures and Antibiotics’
You will see an Occupational or Physical
Therapist
Read slide
Ask for refills of medications if needed.
You will get a form to remind you and your dentist that you will need antibiotics before any dental procedure for the next two years

58. Total Shoulder Replacement
Therapy Services:
Focusing on Function

59. Purpose
To discuss what to expect in therapy the first days after surgery
To identify Total Shoulder motion precautions
To discuss home exercise program
To identify what you need to do to achieve the best outcome

60. After Surgery
You will wear a sling except when performing self-cares and exercises
You can move your elbow, wrist and fingers
You should not move your shoulder until you have assistance from nursing or a therapist

61. Therapy is important for a good outcome!
After Surgery
Therapy is important for a good outcome!
Therapy starts the day after surgery
You will learn motion precautions for your healing shoulder
You will learn how to move your arm safely when:
Taking care of yourself
Taking sling on/off
Walking/moving about

62. Therapy After Surgery
Therapy Goals:
PASSIVE range of motion of surgical shoulder (Maximum: degrees flexion, 40 degrees external rotation)
Control pain and swelling
Be independent in taking care of yourself and moving your shoulder
Prepare for a safe return to home

63. Activity limitations Limit shoulder elevation to 140 degrees flexion
Limit shoulder external rotation to 40 degrees

64. Therapy for home You will learn a home exercise program that includes:
Passive range of motion for your shoulder (no muscle flexing)
Active range of motion for your elbow, wrist and fingers (moving them on your own)
Techniques to control swelling and pain
It is recommended that a person be available at home to assist you

65. At home you will: Continue with range of motion exercises
Wear immobilizer/sling
Practice your total shoulder precautions
Call the therapy department with questions or concerns
Comment: Do not baby the arm. You may lose muscle mass. Strengthening and moving your shoulder will always make your shoulder feel better in the long run.

66. You are a Partner in Your Care!
Make your plans…
Start getting ready for surgery!

67. Social Services and Case Management

68. Roles of Social Services and Case Management in Your Care
Social Workers and Nurse Case Managers work in teams to assist with:
Insurance
Counseling/support
Transition planning
Advance Directives for Healthcare

69. Insurance
Before surgery, you will need to notify your insurance company of your surgery plans
Once you are in the hospital, your Nurse Case Manager will monitor your approved stay days and be a contact person for your insurance company for any questions or concerns
INSURANCE
Notification of elective surgery is NOT required for those who have only Medicare as their insurer. Medicare rules do not require pre-authorization of elective surgery.
Many Medicare Advantage plans and private insurance companies do require notification of elective surgery by both the surgeons office and the patient themselves. Although this is not the case for every Medicare Advantage plan and private insurance plan, play it safe by notifying your Medicare Advantage plan or private insurance plan yourself about your surgery plan.
Prior authorization for surgery can take anywhere from days to process, so call your insurer as soon as you know your scheduled surgery date.
If for any reason your insurer denies your prior authorization request, the hospital will be notified and we will contact you to let you know your request was denied.

70. Counseling and Support
Surgery and hospitalization are stressful
Meeting your emotional needs is important to all staff at Luther-Midelfort
If you have any concerns about your care or are feeling “out-of-sorts”, please feel free to discuss these things our Social Services staff

71. Discharge Planning
A Social Worker or RN Case Manager will meet with you to discuss your transition plan to home or a transition facility.
You, your family, your doctor and your therapist all will help determine what transition plan is best for you.

72. Options at Discharge Home with family to care for you
Home with outpatient services
Home with or Home Care
Skilled Nursing Facilities
Transitional Care Units or Swing Beds
TRANSITIONAL CARE OPTIONS
Home with outpatient services is an option for the person who is generally in good health, has someone available to stay with them the majority of the time for a few weeks, has progressed sufficiently in therapies during hospitalization, and is self-motivated to perform their exercises at home on a consistent basis.
Home with Home Care services is an option for the person who has a skilled nursing need such as complex dressing changes or IV antibiotics. Physical Therapy is available through home care agencies but because of the shortage of therapists, generally the maximum amount of home therapy they can provide is 2 times a week. In addition to having a skilled nursing or skilled therapy need, home care also requires that you are “homebound”, meaning leaving your home requires a great deal of effort.
Skilled Nursing Facilities are area nursing homes that offer short term rehabilitation stays along with their long term care. This is an option for the person who requires more assistance to ambulate or care for themselves than their family or friends can safely provide. It is also an option for the person who lives alone and may not have someone that can be available to them at all times during the day, or the person who needs the extra motivation and skill of a trained therapist. Remember, for the best recovery, therapy needs to start early and be consistent.
Transition Care Units or Swing Beds are located in a rural hospital and your care is provided by the hospital staff and a hospital physician will assume your care while you are receiving services at the Swing Bed. This is an option for the person who has a more skilled nursing care need, examples would include complex dressing changes or difficult to control blood sugar levels or a pre-existing medical issue such as cardiac disease. Swing Beds can also provide more intensive rehabilitation therapies than the Skilled Nursing Facilities.

73. Advance Directives for Healthcare
What are Advance Directives?
What are the 2 types of Advanced Directives?
ADVANCED DIRECTIVES FOR HEALTHCARE
Advanced Directives are written documents that tell your Doctor what you want for care when you are unable to speak for yourself.
They allow you to describe the type of medical treatment your would like to receive or not receive.
They allow you to identify the person you wish to be your decision maker if you are unable to make your own health care decisions.
There are 2 types of Advance Directives, Declaration to Physicians or Living Wills, and Power of Attorney for Health Care.

74. Declaration to Physicians or Living Wills
Describes the kind of life-sustaining care you would want only if you had a terminal condition or were in a persistent vegetative state
Living Wills direct your physician regarding life-sustaining treatment or a feeding tube
Living Wills do not give authority to anyone to make health care decisions on your behalf

75. Power of Attorney for Health Care
Your agent can tell your physician what kind of care you would want in all types of health decisions, not just concerning life-sustaining treatment
You appoint an agent to make all health care decisions for you in collaboration with your physician
In most cases, going to court to appoint guardianship can be avoided
POWER OF ATTORNEY FOR HEALTH CARE
This document is recommended because it is much more flexible than the Living Will and gives health care providers a person to discuss your wishes with.

76. Who Can Help you Complete an Advance Directive?
Luther Hospital Social Services-no cost
Luther Hospital Chaplaincy-no cost
Your personal attorney-attorney fee

77. Safekeeping of Advance Directives
Store the original document in a safe place
Give a copy of the document to family members
Give a copy of the document to your Physician so that it can be kept in your medical record

78. To complete an Advance Directive or for any questions
Call Social Services Department at
, or
Ask for a Social Worker or Chaplain when you are admitted to Surgi Center the day of your surgery.