Altered Sexuality Patterns

Altered Sexuality Patterns

Instructions: Fill out this form, print it, and hand it in with your assessment to your instructor. If you save the page with new name, you can use it again for future clients with minor changes as needed.

AOL users: Read this instruction.

Definition:state in which an individual expresses concerns regarding his/her sexuality or is experiencing a change in sexual health.

1. Your initials (required):

2. Defining Characteristics- check those that apply to your client:

None- high risk diagnosis reports difficulties in sexual behaviors or activities anticipates difficulties in sexual behaviors or activities

3. Related Factors- check those that apply to your client:

limitations imposed by disease (diabetes, congestive heart failure, COPD, for example) side effects of medications
stress surgery (hysterectomy, prostatectomy for example) lack of significant other environment (lack of privacy for example) anxiety maturational (adjustment to new parenthood, pregnancy, aging) pain

4. Goal (ultimate, long term)

5. Outcome Criteria (short term)

6. Evaluation: Was the outcome criteria met?

Yes- Give Evidence:

No- Explain how you would change the plan:

7A. Interventions

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7B. Rationale for each intervention

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