Altered Sexuality Patterns

Altered Sexuality Patterns

(_)Actual (_) Potential

Related To:
[Check those that apply]
(_) Cardiac disease
(_) Chronich respiratory disease
(_) Medication
(_) Metabolic disease
(_) Neurological disease
(_) Penile prosthesis
(_) Prostatectomy
(_) Other:_____________________________
____________________________________
____________________________________

As evidenced by:
[Check those that apply]
Major:
(
Must be present)
(_) Identification of sexual difficulties, limitations, or changes.

Date &
Sign.
Plan and Outcome
[Check those that apply]
Target
Date:
Nursing Interventions
[Check those that apply]
Date
Achieved:
The patient will:

(_) Experience sexual pleasure as defined by self and partner.

(_) Learn alternative ways of sexual expresiion.

(_) Other:

(_) Assess patient's current satisfaction with sexual functioning.

(_) Discuss with patient potential etiological factors for a change in sexual functioning.

(_) Teach patient necessary information regarding implantable devices. eg. penile prosthesis.

(_) Referral to:_________________
________________________
________________________

(_) Other:________________
________________________
________________________
________________________

__________________________
Patient/Significant other signature

__________________________
RN signature

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