Altered Sexuality Patterns
Altered Sexuality Patterns
(_)Actual (_) Potential
| (_)
Cardiac disease (_) Chronich respiratory disease (_) Medication (_) Metabolic disease (_) Neurological disease |
(_)
Penile prosthesis (_) Prostatectomy (_) Other:_____________________________ ____________________________________ ____________________________________ |
| 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