Angelite Nurses: 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

Angelite Nurses