Monday, March 25, 2019



May 25, 2019

Jenkins is the creator of the bestselling Left Behind series.

Becoming a writer seems glamorous. I became a writer because I had a message, wanted to make a difference, touch other people. Strong desire leads to fear of mot succeeding, thus procrastination, “writer’s block.”

Number one complaint of writers is fear. They cannot achieve their dreams because of it.

If you have a dream, you have come to the right webinar to get help.

I’ll teach you nine secrets to conquering that fear. I’ve averaged over four books a year, selling tens of millions. I, too, was once unknown and unpublished.

  1. Set a sacred deadline. Tell others. Commit. Calculate pages/day to make your deadline. Schedule some procrastination and work time. Recalculate the pages/day needed as you approach the deadline.
  2. Establish a daily writing routine. Stick to it. Minimize social media involvement.
  3. Celebrate small gains. Title, subtitle, dedication, acknowledgment, epigram, Prologue, first paragraph…print them out. You have started. Next day, another small goal.
  4. Always think “reader-first.” What will make this most interesting?
  5. Know your why. Recall the reasons you wanted to write this book? What is your “why”?
  6. Make time to write. Schedule, sacrifice. Even three hours per week.
  7. Make yourself accountable to someone else. Tell them how you are doing.
  8. Join a writers’ group to work together with.
  9. Find a mentor…to learn the craft and help you overcome barriers.


This talk was followed by a description/pitch for a writing program being sold by Jenkins et al., The Jerry Jenkins Writers Guild.  There are self-study courses, with detailed roadmaps, master classes, fiction and non-fiction. Sessions are recorded and archived and put into pdf files. E.g., self-editing, dialog, point of view, show don’t tell, your first five pages, prefect itch, theater of your readers mind, main characters, memoirs, how-to…all available in the archives.  

Manuscript repair and re-write: JJ edits the first page of a student’s work. Highly popular sessions. Show what must be changed and why. Example helps students do it for themselves.

Office hours make JJ available online.

Motivated, caring communities of fellow students. 2000 members.

These benefits raise your confidence and improve your performance, getting you to your published book.

What is the cost? $45 / month. Sign up online.


If you want my coaching/editing help for your book, contact me at I am not Jerry Jenkins, but you will not be one of thousands in a group, but one of a few, getting personal attention. It is the difference between getting books/videos etc. or getting a personal coach/editor.

Douglas Winslow Cooper, Ph.D.

Friday, March 22, 2019

MANAGE NURSING CARE AT HOME, Ch. 16, Reproductive and Urinary Systems

The organs and functioning units in the reproductive system differ between males and females.  While the basic function of the system, whether male or female, is to produce reproductive cells, gametes; males produce them by way of testes and females via ovaries. 

Regardless of the sex, both reproductive systems require tubes by which the gametes are transported for the union of sperm and eggs (ova) for fertilization and formation of a new organism. 

The male reproductive system includes the penis, vas deferens, testes which produce sperm, and glands which secrete fluids and hormones for the reproductive task. 

The female reproductive system includes the vagina and vaginal canal, fallopian tubes, ovaries which produce ova, uterus, and glands which secrete different hormones and fluids, in a similar fashion necessary for reproduction. 

The reproductive system is often assessed with the urinary system.  In fact, portions of the reproductive system are combined with the urinary system.  This is termed the urogenital system. 

Numerous disorders can occur in the reproductive system.  They are often related to cancer, such as ovarian, uterine, testicular, for example.  Other problems result in infection or excessive growth of glands such as the prostate, as exhibited with prostatitis and benign prostatic hyperplasia (BPH), respectively, in males, causing difficulties in urination, for example.  Females often exhibit problems and disorders with menstruation when abnormal and excessive uterine bleeding, lack of menstruation, (amenorrhea) or painful menstruation (dysmenorrhea).

Many disorders and problems affecting the reproductive system require surgical intervention.  Once the dysfunctional organ is excised (removed), home care considerations then relate to post-surgical care, which includes assessing for signs and symptoms of infection, promoting healing, and allowing time to return to normal function. 

Reproduction is the process by which new life is formed.  While the method is very different for plants versus animals, the outcome is the same.  The purpose of reproduction is to produce new life to ensure the species not only continues, but thrives.  Genetic material is passed down from generation to generation.  However, duplication is not the sole purpose.  Replication of the species’ best properties are passed down and changes to the genetic material are made over time to propagate and enhance the entities, resulting in increased chances of survival as well as a stronger, and sometimes more advanced organism.

In humans, the goal of reproduction is to produce children who are biological descendants, as well cultural, traditional, and familial offspring.  This is accomplished by a union of male and female genetic material brought together via sexual reproduction.  To complete this task, although the two sexes have different anatomy and function independently, they work together (synergistically) to obtain one outcome: fertilization of reproductive cells (gametes) for formation of a new organism. 

Gametes include sperm in males and eggs (ova) in females.  Both sexes have structures (gonads) that produce gametes, with tubes and ducts for gamete transportation, and glands which secrete substances to support and enhance survival of the gametes and fertilization.

In males, the gonads that continually produce sperm throughout a male’s lifetime are the testes.  Testes are dual oval-shaped glands which also have cells producing fluids to nourish sperm and others which produce the hormone testosterone.  The testes are held in place by the scrotum which functions to adjust the temperature within the testes necessary for sperm viability and development.  Muscles in this tissue contract with decreased temperature to bring these organs closer to the body to provide warmth.  In contrast, these muscles also relax to lower them from the pelvis for cooling. 

Mature sperm are transported to and stored by the ductus deferens (also called the vas deferens) which also functions to force sperm to a portion of the urethra (the prostatic urethra) during ejaculation via the penis.  Other accessory sex glands produce and secrete substances that form semen, the liquid portion of ejaculated fluid that does not include sperm.  Semen provides a substance for sperm transportation and motility as well as neutralizing fluids to promote their viability to increase chances of fertilization.

In females, the gonads that produce eggs (“ova”: singular is “ovum”) are the ovaries.  Like male testes, these are dual almond-shaped glands but contained within the body; they store and mature ova prior to their release during ovulation.  Historically it was believed that ova are not constantly produced and that the number present at birth remains static until death.  This is the opposite of sperm production.  However, some evidence suggests that this may not be the case but has yet to be determined conclusively.  

The ovaries also secrete the hormones estrogen and progesterone to assist in the maturation process of an ovum along with other hormones, as well as prepare the female body for implantation if fertilization should occur.  Once an ovum has matured and is released from an ovary, it is transported via the uterine (or fallopian) tubes, where fertilization by sperm usually occurs, to the uterus.  Regardless of whether the ovum was fertilized, the fallopian tubes provides the route for the egg to reach the uterus. 

If the ovum is fertilized, it will implant itself in the uterine wall for growth, maturation, and development into an embryo and later, a fetus.  If unfertilized, it will eventually be discarded with uterine tissues during menstruation.  The vagina is basically a structural passage that allows transport into and out of the uterus.  Sperm moves from the penis into the vagina during intercourse.  Sperm then proceeds into the uterus into the fallopian tubes to fertilize ova.  If the ovum is fertilized, during birth it serves as part of the birth canal.  If fertilization does not take place, the vagina functions to eliminate and evacuate uterine blood and tissues during menstruation.  

In addition to the overview of the structure and function of the male and female reproductive system presented here, there are other structures which have not been described.  In addition, disease process and illnesses are also not addressed, as many interventions are dictated around medications or surgical procedures. Lastly, although this system is often addressed and assessed in conjunction with the urinary system; nevertheless, they are two very distinct and separate systems. 

In this section, urinary disorders will be addressed. 

While the digestive system’s large colon eliminates solid waste, the urinary system functions in a similar capacity in the removal of liquid waste via the kidneys.  By using a complex method of filtration, various tubes throughout the system capture and retain needed bodily fluid, minerals, and electrolytes, and the remaining fluid and non-essential substances are stored in the bladder to be later excreted as urine.  In addition, the system helps to regulate calcium and the acid-base (pH) balance of the body. 

The urinary system is comprised of the kidneys (to regulate the amount and composition of the blood by producing urine), ureters (to move urine from the kidneys), bladder (to hold and store urine received from the ureters), and urethra (to release urine from the bladder for elimination outside the body).   While the functional elements of the urinary system do not differ between males and females, the length of the urethra does.  Therefore, females are more prone to urinary tract infections. 

The kidneys are the main organ of this system and are comprised of small units (nephrons) that filter the body’s blood.  Besides maintaining fluid balance by eliminating excess water, they perform many other functions.  They regulate the composition of fluid by removing or retaining various electrolytes such as hydrogen, sodium, potassium, chlorine, and regulate the body’s pH within a small range of 7.37 to 7.43.  Too much retained hydrogen results in metabolic acidosis; too little results in metabolic alkalosis. 

By regulating the amount of water that is retained in the body, the kidneys assist in the regulation of blood pressure.  This system also produces erythropoietin when the body’s blood oxygen supply is decreased.  This hormone then prompts the bone marrow to produce red blood cells.  Also, they synthesize vitamin D.

Disorders of the renal (kidney) system can be acute or chronic.  The severity dictates whether measures are required to provide or enhance elimination of urine, as well as provide filtering of the blood.  Acute renal failure can resolve, and normal function may resume.  Chronic renal failure is irreversible and may require dialysis to remove toxins and fluid that the kidneys are no longer able to remove via filtration. 

Hyperplasia (abnormal growth) of the prostate gland in males can restrict urine to pass, causing a feeling of urgency, a slow stream, and incomplete evacuation of the bladder.  Medication often enhances flow but at times surgical intervention is necessary.  Other methods of urinary elimination may take the form of catheters or surgical urinary diversions.

Some of the various urinary system conditions and care considerations that may be experienced in the home-care setting appear below.

Chronic Renal (Kidney) Disease: is caused by a gradual and prolonged destruction of nephrons, which results in the inability to filter enough fluid and waste from the blood.  This disease often results from infection, diabetes, or high blood pressure.  As the amount of functioning nephrons declines, filtering the blood of toxins and waste decreases as well.  At the point at which most nephrons no longer function and the substances in the blood that are normally filtered and excreted by the kidneys remain, uremia results, a toxic situation causing harmful conditions in many other bodily systems.   At this point, because the kidneys no longer are functioning sufficiently, dialysis is usually necessary to remove excess fluid and toxins from the blood.  

Excess fluid in the blood (hypervolemia) can contribute to cardiac problems such as increases in blood pressure and pulses or lead to congestive heart failure.  Respiratory complications are evidenced by crackles (a type of adventitious lung sounds) or life-threatening pulmonary edema.  Generalized edema is noted in feet, ankles and puffiness around the eyes.  However, the opposite is also possible, and too much water is lost by lack of reabsorption (hypovolemia).  This can lead to dry and scaling skin, hair, and nails, and lack of skin turgor (firmness). 

Waste build-up in the blood causes retention of potassium (hyperkalemia) which can cause cardiac arrhythmias, malaise, muscle cramping, paralysis, and even cardiac arrest.  Increases in phosphate (hyperphosphatemia) caused by decreased excretion can also lead to cardiovascular risks. 

Anemia results from lack of red blood cell production when erythropoietin is no longer synthesized.  Weak bones (osteomalacia) occurs due to lack of calcium (hypocalcemia) caused by a decrease in the synthesis of vitamin D by the kidneys.  

Azotemia results when there is an accumulation of nitrogen and urea which are the products of protein metabolism.  As wastes build up, the GI system is also affected, presenting as nausea, vomiting, anorexia, and abdominal pain.  Neurological symptoms appear as confusion, altered levels of consciousness and mentation. 

Acute Renal Failure: is the sudden loss of kidney function.  It may result from the obstruction of blood or from trauma resulting in decreased blood flow to the kidneys, damage to the filtering structures within the kidneys due to toxins or infection, or obstruction of urine outflow.  Often this condition is reversible with the return of most, if not all, kidney function.  Primary treatment is the reversal of the failure’s cause.

Regardless of the cause, the acute disease progression can result in the same or similar symptoms as the chronic disease.  The severity, length, and course of the illness will depend on the damage incurred as well as on the underlying cause.  Typically, however, the healing and recovery process will follow three paths or phases.  The first phase is the oliguric phase, and during this time there is a decrease in urine secretion.  The diuretic phase is the opposite.  During this second phase, urine output is greatly increased.  The last phase is the recovery phase.  It is in this phase that normal function gradually returns, with the elimination of wastes and fluid.  However, if the underlying cause of the acute condition is not reversed, chronic renal disease could follow.

Care Considerations for Chronic Renal Disease and Acute Renal Failure:
1)  Primarily dietary changes are required for both diseases.  However, the acute illness should be temporary, and care involves supportive actions.  Conversely, the chronic disease usually increases in severity with the potential of requiring artificial blood filtering (dialysis).
2)  Depending on the stage of the disease, patients should consume low-protein diets to decrease protein metabolism and the byproducts that the kidneys can’t excrete. 
3)  Electrolyte balance is necessary because the kidneys are no longer able to remove these from the blood, and excesses of some can be damaging to the body, even deadly.  The amounts of potassium and phosphorus require monitoring, and foods that are plentiful in these substances should be avoided.  Some medications are available to bind electrolytes to decrease their availability in the blood and make elimination easier.
4)  Fluid intake should be restricted as in later of stages of the disease, oliguria (decreased urination) or anuria (inability to urinate) result.  Restricting fluid prevents fluid overload, and this can decrease risks for high blood pressure, edema, and pulmonary overload.
5)  Monitor and record fluid intake and output.  Recording both provides indication of fluid retention in the body.  Daily weights can also provide insight with respect to excess fluid in the body.
6)  Restrict sodium to decrease water retention. 
7)  Assess for signs and symptoms of uremia caused by nitrogen substances that are retained in the body.  Symptoms include dizziness, nausea, vomiting, coma, convulsions, hypertension, hard rapid pulse, dry skin, oliguria or anuria, odor of urine on the breath or in perspirations.  Treatment often requires dialysis
8)  Due to weakness from toxin build-up or increased fluid retention, mobility could be an issue.  Perform range of motion exercise and position changes.  Safety measures include neurological assessments for dizziness or confusion (altered mentation) as well as muscle fatigue, cramping, and weakness from excess potassium.
9)  Administer medications as ordered.  Numerous drugs assist in the conditions associated with kidney disease.  Anti-hypertensives are prescribed to lower blood pressure.  Diuretics are taken to promote urination and decrease fluid retention when the ability to void is present.  Anti-emetics are used to decrease nausea, vomiting, and gastrointestinal irritation.  Laxatives and stool softeners are used to promote bowel elimination which can be a secondary problem due to lack of fluids, limited mobility, and dietary changes.  Iron supplements may be used to combat anemia.  Synthetic erythropoietin may be injected to promote formation of red blood cells.  If this is ineffectual, blood transfusions may be required.  Anti-pruritics are administered to relieve itching (pruritus) that often results from dry skin.  Electrolyte binding medications may be given to decrease serum phosphate or potassium levels.  These medications will not provide a cure to the disease but can relieve adverse symptoms associated with it.
10)  During the end stage of the disease, some form of dialysis is most often required.

Dialysis: is required during the most severe and final stage of kidney disease (end-stage renal disease).  Dialysis is performed to remove fluid and toxins that the kidneys would normal filter, resorb, and excrete from the body.  The two most common types of dialysis are hemodialysis and peritoneal dialysis.  Whichever method is used, this treatment will continue throughout the life of the patient or until a kidney transplant is performed.

Hemodialysis (HD) filters the blood and is accomplished by a machine that removes “dirty” blood from the body, filters it via a semi-permeable membrane to eliminate toxic materials and electrolytes as well as to maintain proper fluid levels and acid-base balances.  “Clean” blood is then returned to the body.  This type of dialysis requires a surgically made connection or passage (fistula) between a vein and an artery, usually created in the upper extremity, called an arteriovenous (AV) fistula.  Often dialysis is performed at an outside, dedicated dialysis facility three times a week, with each session lasting roughly 4 hours. 

Peritoneal dialysis (PD), although providing the same outcome, uses the peritoneal cavity as the filtering membrane.  A permanent catheter is implanted into the abdomen to instill a warm, sterile dialyzing chemical solution into the peritoneal cavity.  The solution remains for a prescribed amount of time and it then removed.  This process could take place overnight or throughout the day at regular intervals.   The advantages to this type of dialysis are the ability to perform the action individually, and not having to rely on outside intervention or long-lasting appointments.  However, infection at the catheter site or peritonitis can be complications.

Care Considerations for Hemodialysis and Peritoneal Dialysis:
1)  Hemodialysis (HD) uses a surgically fashioned AV fistula or AV graft.  This is created under the skin with no outside route that can lead to infection.  However, during the dialysis process, needles are inserted, and strict aseptic technique is required to prevent infection.
2)  The HD fistula and the extremity in which it is placed require caution, care, and watchfulness to protect that extremity and fistula.  That fistula or graft provides life to the patient.  Blood pressure readings, tight clothing, injury, and blood sampling should not be performed on that arm. 
3)  Peritoneal dialysis (PD) requires strict aseptic technique to perform the procedure.  In addition, dexterity and eyesight is necessary to perform the connections of the dialysis solution to the catheter while maintaining sterility.
4)  The patient using PD needs to adjust his lifestyle to coincide with the dialysis process.  This includes adjusting medication scheduling to coincide with the PD process, especially if it is performed at different intervals on different days, as well as allowing enough time for the instilled solution to remain to complete filtration.  After the solution is instilled, a bloating, full, uncomfortable feeling can be exhibited.  However, the solution must not be prematurely drained.  If the solution is instilled at night time during sleep, changes to the bedroom and sleeping routines may be required.
5)  Proper care to the PD catheter is required.  The site should be assessed for inflammation and infection daily.  If infection is suspected, obtain medical assistance.    
6)  Assess for signs and symptoms of peritonitis with PD.  This can potentially be a life-threatening condition.  Symptoms include chill, fever, fast heart rate (tachycardia), abdominal pain or distention, respiratory difficulty due to decreased effort related to the pain, vomiting, and low blood pressure (hypotension).  Seek medical assistance immediately.

Urinary Diversions: are surgical procedures creating reservoirs for holding urine.  In these procedures, the kidneys function within normal limits.  However, the elimination of urine does not occur due to trauma or cancer of the bladder or urethra, for example.  Urine is merely rerouted and diverted rather than proceeding to the bladder for storage and eventual voiding via the urethra to the outside of the body via the abdomen.    There are two types of urinary diversions:  continent diversions and incontinent diversions.  Both types require the patient to be sufficiently dexterous to either perform a sterile catheterization or change outside appliances. 

Continent diversions are internal pouches created from a portion of the large intestine.  A stoma is created with a closure piece that is like a valve that can be opened or closed at will.  This eliminates urine leakage.  The reservoir is internal but self-catheterization is required to empty urine from the pouch, and this is required approximately four to six times per day.  In addition, because the pouch is created from a segment of the large intestine, which produces mucus to aid in stool elimination, the reservoir requires irrigation to decrease potential for blockage from the mucus.  However, there are no outside bags to collect urine, no leakage, and clothes can be protected with the use of a small piece of gauze to trap mucus.  Sterile technique is required during the procedure.

Incontinent diversions are like colostomies which reroute stool from the colon to an outside collection appliance.  The difference is that urine is collected.   With this type of diversion, there is an opening directly to the abdominal wall.  Appliances are always required, and the bags must be emptied frequently.  However, there is no sterile technique required and no irrigation.  The bag is held in place, again similar to colostomies, by adhesives.  But these can be irritating to the body. 

Care Considerations for Continent Urinary Diversions:
1)  Sterile technique is required when emptying the pouch during catheterization.  It is also essential to clean the site before and after the procedure.  Before catheterizing (or intubation), clean the stoma in outward circular motions with a prescribed cleansing agent (such as providone-iodine).  When done emptying the pouch, again clean with gauze and liquid soap, rinse, and pat dry.  Care to the stoma and nearby (peristomal) skin as well as sterile technique is essential to maintenance of the device and to minimize risk of infection.
2)  Before inserting catheter, lubricate with a water-soluble lubricant.  Using petroleum-based products increases risk of infection.  Lubrication also decreases damage to the valve when inserting the catheter.  Gently insert the catheter using a rolling motion in minimize damage, and continue until urine flows.  Taking deep breaths during insertion or changing positions can aid in inserting the catheter if resistance is felt.
3)  During irrigation, after emptying the pouch at regular intervals, irrigate and instill sterile normal saline.  The amount and time frames when this is required should be prescribed.  Irrigation is required to prevent blockage that can occur due to the mucus produced by the large intestines.  The saline will drain with gravity.
4)  Before the catheter is removed from the valve, patient should cough a few times.  This will help expel residual urine and/or normal saline from the pouch. 
5)  After intubation catheter use, clean as recommended by manufacturer or physician, or discard if single-use only.  If reusable, be sure to rinse well to clear all mucus.
6)  Ensure a catheter is always available and ready to use.  Keep track of intubations to ensure the reservoir does not become too full.  In time the size of the pouch will increase.  Damage to the reservoir or urine leakage could occur with too much urine volume. 
7)  Body image disturbances are common, especially after initial creation.  Provide encouragement, supportive communication, and patience.  Help with tracking intubation times and provide gentle reminders if necessary.  Allow patient to express difficulties and vent frustrations but direct him to positive outcomes.

Care Considerations for Incontinent Urinary Diversions:
1)  When applying new ring and appliance, ensure that measurements of the stoma compared to the outside appliance ring and pouch are within a small margin for proper placement around the stoma.  This is usually 1/16 to 1/8 of an inch.  If the ring is too large, leakage may happen.  If it is too small, damage to the stoma could occur. 
2)  After emptying the pouch, cleanse the stoma and area with soap and water.  Pat the skin dry to decrease possible irritation.  Apply skin preparations, if so advised, to help adhere appliance and provide protective barrier to the skin.  Then apply ring and appliance and hold in place to ensure a solid seal.
3)  At night, the pouch can be connected to a drainage bag for continuous removal via gravity.  This helps to eliminate leakage or build-up of urine that can create difficulties during sleep when volume is not attended to.
4)  Body image disturbances are common especially after initial creation.  Provide encouragement, supportive communication, and patience.  Offer to assist with measuring appliance and skin care.  Allow patient to express difficulties and vent frustrations but direct him to positive outcomes.

Urinary Catheterization:  is performed to allow urine to flow from the bladder for elimination outside the body.  This may be required when spinal cord injuries prevent normal voiding due to loss of function from spinal nerve damage.  Often fully incontinent patients are catheterized to prevent spontaneous voiding which could cause damage to skin due to moisture and the acidic nature of urine.  Other times, it is done to provide a “normal” lifestyle.  Besides providing a means to eliminate and collect urine, sterile urine sampling can be obtained for diagnostic testing related to urinary tract infections, for example.  There are many types of catheters that can be used.  These include indwelling bladder catheters, intermittent catheterization, and condom catheters for males.

Indwelling catheters are often used in hospital and nursing home settings due to incontinence but are also used when obstruction prevents normal urination.  These catheters are inserted into the urethra up to the bladder.  After placement is established by the flow of urine, sterile normal saline is inserted into a balloon to hold the device in place.  Urine is then eliminated via gravity into a collection bag.  Risk for infection can be high during placement as well as during the time the catheter is in place.  In some cases, kidney disease can result due to upward moving infections that traveled along the catheter to the bladder eventually affecting the kidneys. 

Intermittent catheters are preferred to indwelling catheters, which cause increased risk of infection to the urinary tract. However, catheterization is required often, and this increases the infection risk during each insertion.  This form of catheterization is often necessary for paraplegics and individuals with spinal cord injuries.  Although there is no obstruction of the urethra, signals from the brain are blocked and prevent normal voiding.

A condom catheter is specific to incontinent males.  As the name suggests, a condom-like apparatus is place over the penis and urine flows from the condom via tubing to a collection bag that is placed on the leg.   There is virtually no loss of mobility.  Although risk for infection always exists, there is no invasive procedure to the sterile bladder cavity.  The bag is emptied when approximately half full.  There is, unfortunately, no similar solution for females.

Care Considerations for Urinary Catheterization:
1)  All catheters are vulnerable to urinary tract infections that may result during placement or dwell time.  Strict sterile technique is required for placement, without exception, as the urinary system is a sterile one and is easily contaminated.  Infections in the bladder, for example, can progress upward to the kidneys and cause irreparable harm to kidney function.  In addition, extreme results can result in septicemia which is an infection that spreads to the blood. 
2)  Whether an intermittent or indwelling catheter is placed, consideration is required concerning the sex of the patient.  The male patient’s urethra is very long and typically extends approximately 12 to 13 inches before reaching the bladder.  In contrast, the female urethra is only about 5 inches in length.  Continue to slowly progress the catheter until urine is expelled, using sterile technique during the entire time.  Stopping and restarting the procedure prolongs discomfort and increases the risk for infection.
3)  The patient will normally experience pressure and discomfort during the process if sensations are recognized.  In addition, often the bladder is distended which causes discomfort itself.  Deep breaths will help advance the catheter.  Ensure sufficient lubrication is provided on the catheter before insertion.  Relief will be felt immediately upon entering the bladder.
4)  If the patient is an uncircumcised male, the penis foreskin must be pulled back.  Ensure that the foreskin is replaced and returned to the original position prior to the catheterization. Retracted foreskin can cause damage due to potential lack of blood supply to the organ.
5)  Once the catheter enters the bladder, urine will flow.  Normal voiding occurs when the bladder contains approximately 250mL.  The maximum immediate outflow of urine after catheterization should be no more than 1000mL.  Exceeding this amount can cause detrimental fluid shifts within the body.
6)  If an indwelling catheter is placed, remove it as soon as possible to decrease risk for infection.


Contact information:
Diane R. Beggin, RN
40 Sycamore Drive
Montgomery, NY 12549

Web site:

Book: HOW TO MANAGE NURSING CARE AT HOME, by Cooper and Beggin

WHAT EVER HAPPENED...? "Brain Tumor Vigil"

A Service of Healing, Remembrance, Advocacy and Hope*
created by The Healing Exchange BRAIN INJURY TRUST ©2000-2008

We would be grateful if you would please acknowledge T.H.E. BRAIN TRUST when you use this service we created. We wish you courage, peace and blessings. We send our appreciation for your participation in this special community.

I. Introduction

As we gather together in support of those who need healing, and in remembrance of those who are no longer here, let us join our thoughts and prayers. Our presence as a community strengthens those who are healing, and our words reach out to comfort those who are grieving. May all who are here today be blessed with health and strength, and may all who are mourning find serenity and peace.

II. Responsive reading – a prayer of remembrance

READER: In the rising of the sun and in its going down, we remember them.

TOGETHER: In the blowing of the wind and in the chill of winter, we remember them.

READER: In the opening of buds and in the rebirth of Spring, we remember them.

TOGETHER: In the blueness of the sky and in the warmth of summer, we remember them.

READER: In the rustling of the leaves and in the beauty of Autumn, we remember them.

TOGETHER: In the beginning of the year and when it ends, we remember them.

READER: When we are weary and in need of strength, we remember them.

TOGETHER: When we are lost and sick at heart, we remember them.

READER: When we have joys we yearn to share, we remember them.

TOGETHER: So long as we live, they too shall live, for they are now a part of us, as we remember them.

III. Reading of Names

READER: At this time, we remember and honor those who have been diagnosed with brain tumors. Some of these people are no longer living, but their memories continue within us. Others are living their lives as brain tumor survivors, with all of the challenges that surviving may involve for themselves and their loved ones. We send out hope and healing to each of these gentle spirits and to their families and loved ones.

[Read any names you have collected]

In addition to those names read aloud, we invite anyone here to come forward and speak a name or names, including their own. Each of us can also silently acknowledge loved ones and friends that have been affected.

[at conclusion of reading of names]

READER:   Out of the glaring darkness of life's chaos,
we must struggle for the words
that will bring light and understanding.
May we be blessed with clarity of thought,
mindfulness of the blessings that surround us,
and a vision of peace.

Life is eternal, love is immortal, and death is only a horizon.
A horizon is but the limit of our sight.

IV. Hope and Healing – a prayer for renewed health

READER: Let us send healing thoughts and prayers to everyone diagnosed with a brain tumor. Research shows that prayer can help in healing. Our gathering is powerful.

TOGETHER: Let us focus our loving attention on everyone in our community in need of healing. May they be restored to renewed health.

READER: Each of us can silently acknowledge loved ones and friends, both present and absent ones who are in need of our prayers.

[A moment of silence is observed]

READER: May all who are ill or suffering find peace and comfort.

TOGETHER: May all who encounter challenges – physical or emotional – find their strength and courage increasing each day.

READER: Grant to all who are in need of healing, the consolation of hope.

IV-ii. REFLECTIONS (At this time in the service, gathered members may be asked for additional reflections on healing. Poems, songs or any thoughts are welcomed. This section may be included as time permits)

V. A Prayer for Our Community
(with opening REFLECTIONS if time permits)

READER: May all who are living with brain tumors find compassion, comfort and support from our community

TOGETHER: May everyone in a position to make important contributions to brain tumor research, treatment, and prevention be empowered to do so.

READER: May all people affected by brain tumors, their families, friends, and their lay and professional caregivers, be blessed with courage and hope.

TOGETHER: Allow us to find new meaning in the challenges we encounter.

READER: Grant everyone affected by a brain tumor the blessings and strength of a caring, supportive community like the one we have gathered today.

TOGETHER: Grant us the vision to understand how we can work together.

READER: May all whose lives have been changed by a brain tumor find inspiration to adapt to new ways of living.

TOGETHER: May all of us find comfort knowing that we are not alone, as we encourage one another and share our experiences together.

READER: May we all be blessed with health and strength, as we continue our efforts on behalf of the global brain tumor community.


VI. Closing Prayers

READER:   Eternal source of life,
You have called us into life
and set us in the middle of purposes
we cannot measure or understand.

TOGETHER:      Yet we are thankful for the good we know,
for the life we have,               
and for the beautiful gifts that are part of our life each day.
Fill us with hope knowing that
what is good and lovely does not perish.

ALL:          May we go forth renewed in courage and hope. So may it be.

VII. Conclusion and Announcements

*Editorial note: the prayers in this ecumenical service have been gathered from a number of sources including prayer books from different faiths. Original text by Nancy Conn-Levin and Samantha Scolamiero, founder of T.H.E. BRAIN TRUST, is also included in the service.
© The Healing Exchange BRAIN TRUST, Inc.

I (Douglas Winslow Cooper) have been excerpting, weekly, material from this almost-final version of the fine book by Janet Johnson Schliff, M.S. Ed., which she wrote over a three-year period with some coaching and editing help from me, through my business, Write Your Book with Me.

Her memoir is now available in paperback and ebook formats from Outskirts Press  and



More talks are being planned for the spring of 2019… she can be contacted at 845.336.7506 (home) or 845.399.1500 (cell).

Janet Johnson Schliff spoke at the Oblong Books Bookstore in Rhinebeck, NY, on Tuesday, February 6 at 6 p.m.

Janet was on WKNY Radio 1490 in Kingston, NY, on Thursday, March 1 at 9:10 a.m. 

Janet spoke at Barnes & Noble in Kingston, NY, on Saturday, March 3 at 1 p.m. 

Janet spoke at the Starr Library in Rhinebeck, NY, on March 6 
at 7 p.m. 

Janet spoke at the Golden Notebook Bookstore in Woodstock, NY, on March 17 at 2 p.m.

Janet spoke at the Morton Library in Rhinecliff, NY, on March 28 at 6:30 p.m. 

Janet spoke at RCAL in Kingston, NY, on April 3 at 4 p.m. [They gave her an impromptu book-launch party.]

Janet spoke at the Parkinson's Support Group at the Starr Library in Rhinebeck, NY, on April 4 at 2:30 p.m.

Janet spoke at the Stone Ridge Library in Stone Ridge, NY, on April 27 at 5:30 p.m.

Janet spoke at the Hurley Library in Hurley, NY, on May 4 at 6 p.m.

Janet spoke at the Kingston Library in Kingston, NY, on May 9 at 6 p.m.

Janet spoke at the Staatsburg Library in Staatsburg, NY, on May 14 at 7 p.m.

Janet spoke at the Clinton Community Library in Rhinebeck, NY, on May 31 at 6:30 p.m.

Janet spoke at the Mountain Top Library in Tannersville, NY, on June 9 at noon.

Janet spoke at the Gardiner Library in Gardiner, NY, on June 11 at 7 p.m.

Janet spoke at the Marbletown Community Center in Stone Ridge, NY, on June 20 at 6 p.m.

Janet was interviewed on radio station WTBQ-FM (93.5) on June 29 at 12 p.m.

Janet spoke at the Esopus Library in Port Ewen, NY, on July 13 at 7 p.m.

Janet spoke at the Pine Plains Library in Pine Plains, NY, on July 20 at 6 p.m.

Janet spoke at the Ulster Library in Kingston, NY, on July 23 at 5:30 p.m.

Janet spoke at the Northern Dutchess Bible Church in Red Hook, NY, on August 11 at 1 p.m.

Janet spoke at a writers' group in Rosendale, NY, on August 30 at 2 p.m.

Janet spoke at the Inquiring Minds Bookstore in New Paltz, NY, on September 6 at 7 p.m.

Janet spoke at the Adriance Library in Poughkeepsie, NY, on September 15 at 2:30 p.m.

Janet was interviewed on radio station WRIP-FM (97.9) on September 21 at 8 a.m.

Janet again spoke at the Mountain Top Library in Tannersville, NY, on September 22 at noon.

Janet spoke at the Enchanted Cafe in Red Hook, NY, on September 28 at 7 p.m.

Janet spoke at the Hyde Park Library in Hyde Park, NY, on October 4 at 7 p.m.

Janet participated in an Author Weekend at the Barnes & Noble in Poughkeepsie, NY, on October 14 from 11 a.m. to 3 p.m.

Janet spoke at the Tivoli Library in Tivoli, NY, on October 22 at 5:30 p.m.

Janet’s interview for the TV program Wake Up with Marci on the You Too America Channel aired on Monday, November 5, and Friday, November 9. It can now be found on the Internet.

Janet spoke at the Germantown Library in Germantown, NY, on November 7 at 6:00 p.m.

Janet participated in the Red Hook Middle School's College and Career Cafe in Red Hook, NY,  on December 19 at 10:30 a.m.

Janet will speak at the Poughkeepsie Brain Injury Support Group at the Poughkeepsie Galleria Mall in Poughkeepsie, NY, on Saturday, February 23 at noon. 

Janet will speak at the Stanford Free Library in Stanfordville, NY, on Saturday, March 9 at 10:00 a.m.

Janet will speak at the Howland Library in Beacon, NY, on Wednesday, March 20 at 1:00 p.m.

Janet will speak at the West Hurley Library in West Hurley, NY, on Saturday, March 23 at 1:00 p.m.

Janet will speak at the East Fishkill Library in Hopewell Junction, NY, on Monday, March 25 at 6:30 p.m.

Janet will speak at the Grinnell Library in Wappingers Falls, NY, on Saturday, March 30 at 10:30 a.m.

Janet will speak at the Dover Plains Library in Wingdale, NY, on Friday, April 5 at 6:00 p.m.

Janet will participate in an Author Talk at the Saugerties Library in Saugerties, NY, on Saturday, April 13 at 1:00 p.m.

Janet will speak at the Red Hook Community Center in Red Hook, NY, on Wednesday, April 24 at 5:00 p.m.

Janet will speak at St. Timothy's Church in Hyde Park, NY, on Sunday, May 5 at 11:00 a.m.

Janet will speak at the Moffat Library in Washingtonville, NY, on Saturday, May 11 at 1:00 p.m.

Janet will speak at the Beekman Library in Hopewell Junction, NY, on Saturday, May 18 at 10:30 a.m.

Janet will speak at the Pleasant Valley Library in Pleasant Valley, NY, Tuesday, May 28 at 6 p.m.

More talks are being planned for 2019… contact her at 845.336.7506 (h) or 845.399.1500 (c).

More signings will be coming up. A fine feature about Janet by John DeSantos [845 LIFE] appeared in the Middletown Times Herald-Record on Monday, March 12, as part of Brain Injury Awareness Month. An article about her book was just published in the May 2018 Living Rhinebeck Magazine. An article about her book appeared in the May 14 Daily Freeman of Kingston, NY. and another in the Family Life section of the Poughkeepsie Journal on June 8th. The Millerton News published an article on Thursday, August 2, about her talk at the Pine Plains Library.