Shadowing Practice: Nitrates: Nursing Pharmacology - Learn English Speaking with Video
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What?
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you Nitrates are medications that come under the umbrella of a larger group called vasodilators, which dilate the walls of blood vessels.
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Nitrates are primarily used to treat angina pectoris, which is pain caused by reduced blood flow to the heart muscle as well as hypertension and heart failure.
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More recently, they've also been approved for the topical treatment of anal fissures.
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The most commonly used nitrates include nitroglycerin, isosorbide dinitrate, and isosorbide mononitrate.
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Out of these, nitroglycerin has a rapid and short -lasting action, so when treating acute anginal pain or hypertension,
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it's typically given through rapidly absorbable routes, like sublingual, oral spray, or intravenously, to bypass the first -pass metabolism in the liver,
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which would slow its absorption.
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For long -term prevention, though, routes of administration can include transdermal patches, topical ointments, or extended -release oral capsules.
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Nitroglycerin can also be administered rectally for the treatment of anal fissures.
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On the other hand, isosorbide dinitrate and isosorbide mononitrate have a longer duration of action and are typically administered orally as tablets,
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or sustained release capsules which makes them useful for the long -term prevention of angina pectoris
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or to treat clients with heart failure.
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Once absorbed into the blood, nitrates quickly get converted into their active form,
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called nitric oxide, Nitric oxide diffuses to the smooth muscle cells of both veins and arteries, causing wall relaxation and vasodilation.
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The result of venous vasodilation is peripheral blood pooling, which in turn decreases the return of venous blood to the heart.
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This way, nitrates predominantly reduce preload, which is the pressure that stretches the heart as it fills with blood from venous return.
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At the same time, arterial vasodilation lowers the systemic vascular resistance, which will also reduce the afterload,
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or the pressure that the heart must work against to eject the blood.
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Ultimately, by reducing preload and afterload, nitrates reduce the amount of work the heart has to do, eventually decreasing the heart's oxygen consumption.
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Nitrates also have a minor effect on the dilation of the coronary arteries, which helps increase oxygen delivery to heart tissue.
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Common side effects of nitrates include headache, dizziness, flushing, nausea, and vomiting.
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Another important side effect of nitrates is orthostatic hypotension, where the blood pressure falls significantly when the client stands up too quickly.
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As a result, these clients could experience lightheadedness or syncope due to decreased blood flow to the brain.
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In addition, clients may experience reflex tachycardia,
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which is caused by the sympathetic system triggering an increase in heart rate in response to the hypotension caused by nitrates, in order to maintain tissue perfusion.
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Now, clients who continuously use nitrates soon develop tolerance to these side effects.
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Unfortunately, clients may also develop tolerance to the therapeutic effects of nitrates, especially with uninterrupted use.
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Clients can prevent this by avoiding using nitrates for several hours each day.
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Finally, nitrates are contraindicated in individuals with hypotension, hypovolemia, severe anemia, and cardiomyopathy.
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Nitrates should be used carefully during pregnancy or breastfeeding, as well as in clients with increased intracranial pressure or cerebral hemorrhage,
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renal or hepatic disease, and syncope.
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As far as drug interactions go, nitrates should never be combined with other substances that cause vasodilation,
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such as alcohol, Medications used to treat erectile dysfunction including sildenafil,
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tadalafil, or vardenafil or antihypertensive agents like beta blockers or calcium channel blockers.
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If taken together, their effects add up and may lead to a steep fall in blood pressure, cardiovascular collapse, and even death.
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Now, before administering a nitrate,
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complete a baseline assessment, including frequency and severity of angina pain and vital signs especially blood pressure.
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Review their health history for angina risk factors, such as hypertension.
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Next, check your client's latest laboratory report including CBC, hepatic and renal function, as well as their lipid profile.
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Then be sure they understand how angina happens, and explain how the medication helps reduce or prevent angina by improving blood flow to the heart.
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Lastly, after administering the nitrate, remain with your client and continuously monitor their vital signs, especially blood pressure.
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Continue to assess for worsening symptoms, such as chest pain and side effects, and for the desired therapeutic response.
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Ok, when teaching your client about sublingual nitroglycerin, explain that nitrates are sensitive to light,
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moisture and heat, so advise them to store their nitroglycerin pills in their original container at room temperature
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but also remind them to carry a small number of their pills with them at all times.
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Teach them that taking a sip of water before putting their pill under their tongue will help it dissolve
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and get into their system faster.
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In addition, let them know that it's normal for them to feel a slight burning
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or tingling under their tongue while the medication dissolves.
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Be sure to remind your client to not swallow the medication
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and instruct them to avoid eating or drinking anything for 15 minutes after administration to ensure the medication is fully absorbed.
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Let them know about common side effects they may experience, such as headache, which can be managed with acetaminophen,
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and orthostatic hypotension, which can increase the risk of falls.
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So teach your client to make position changes slowly, especially if they feel lightheaded.
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Lastly, stress the importance of avoiding other substances that can excessively lower blood pressure, such as alcohol and medications used for erectile dysfunction.
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If your client experiences angina with activity, remind them to take the nitroglycerin prior to precipitating activities or situations,
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such as playing sports or mowing the lawn.
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If they're taking the nitrate for acute angina, instruct them to call emergency services if the pain does not resolve within five minutes after one dose.
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While awaiting emergency care to arrive, let them know that they may take a second and third dose five minutes apart.
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Now, if your client is prescribed transdermal nitroglycerin patches, instruct them to apply a new patch each day on a hairless part of their body.
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To prevent the development of nitrate tolerance, stress the importance of incorporating about 12 hours of nitrate free time every 24 hours, usually during the night.
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For example, if your client has angina with activity, instruct them to apply their patch at 8 a .m and then remove it at 8 p .m.
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Finally, remind your client to take their medication as directed, and warn them that stopping abruptly could result in vasospasm.
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Alright, as a quick recap, nitrates are medications mainly used to treat angina pectoris, hypertension, and heart failure.
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Once administered, nitrates are quickly converted into their active form, nitric oxide, which causes vasodilation and ultimately reduces preload and afterload.
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while improving blood flow through the coronary arteries.
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Clients who are prescribed nitrates should be advised about side effects, including headache, dizziness, flushing, nausea,
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orthostatic hypotension, and reflex tachycardia.
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Nitrates should be avoided in clients with problems such as hypotension and hypovolemia, and they should never be combined with other substances that cause vasodilation,
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such as alcohol or medications for erectile dysfunction.
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Finally, continuous administration of nitrates can lead to tolerance, and clients can prevent this by avoiding using nitrates for several hours each day.
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Bu dersin kelimeleri ve konuşma notları
Bu C1 seviyesindeki konuşma dersi “Nitrates: Nursing Pharmacology” videosuna dayanıyor. En çok tekrarlanan kelimeler: nitrate, client, blood, angina, medication. Bu videoda gölgeleme çalışması için 77 cümle ve 1219 kelime var. Konuşma bölümü 9:21 sürüyor. Konuşmacı dakikada yaklaşık 130 kelimelik dengeli bir hızla konuşuyor; gölgeleme için rahat bir tempo. Kelimelerin yalnızca %70’i İngilizcede en sık kullanılan 3.000 kelime arasında, bu yüzden kelime dağarcığı zorlayıcı.
Bu videodaki önemli kelimeler
Videodaki en ileri düzey 15 kelime, telaffuzu ve anlamıyla:
| Kelime | Telaffuz | Anlam |
|---|---|---|
| nitrate isim | /ˈnaɪˌtɹeɪt/ | nitrat |
| nitroglycerine isim | nitrogliserin | |
| hypotension isim | hipotansiyon | |
| vasodilation isim | /ˌvæ.sə(ʊ).daɪˈleɪ.ʃ(ə)n/ | vazodilatasyon |
| hypertension isim | /ˌhaɪ.pɚˈtɛn.ʃən/ | hipertansiyon |
| tolerance isim | /ˈtɑ.lə.ɹəns/ | tolerans |
| artery isim | /ˈɑɹ.təɹ.i/ | arter, atardamar |
| oxide isim | /ˈɑksaɪd/ | oksit |
| headache isim | /ˈhɛdeɪk/ | baş ağrısı |
| pill isim | /pɪl/ | hap, tablet |
| dizziness isim | baş dönmesi | |
| fissure isim | /ˈfɪʃ.ɚ/ | çatlak, yarık |
| prescribe fiil | /pɹɪˈskɹaɪb/ | reçete yazmak |
| reflex isim | /ˈɹiːflɛks/ | refleks |
| syncope isim | /ˈsɪŋ.kə.pi/ | bayılma, senkop |
Duyacağınız deyimsel fiiller
| Kelime | Anlam |
|---|---|
| add up fiil | birikmek |
| stand up fiil | satmak |
Bu videodaki dil bilgisi
Konuşmacının en çok kullandığı yapılar, videodaki sözcüklerin aynısıyla:
| Yapı | Videoda |
|---|---|
| “Used to” used to + fiil — artık geçerli olmayan eski bir alışkanlık ya da durum | used to treat |
| Edilgen yapı be + fiilin üçüncü hâli — kimin yaptığı değil, ne olduğu önemli | been approved · be administered · is caused |
| İlgi cümlecikleri who / which + cümle — bir kişi ya da şey hakkında ek bilgi | pectoris, which is · capsules which makes · preload, which is |
Dikkat edilecek telaffuzlar
- “th” sesleri: therapeutic /ˌθɛɹ.əˈpjuː.tɪk/, thrive /θɹajv/, sympathetic /ˌsɪm.pəˈθɛt.ɪk/
- “sh” ve “zh” sesleri: vasodilation /ˌvæ.sə(ʊ).daɪˈleɪ.ʃ(ə)n/, hypertension /ˌhaɪ.pɚˈtɛn.ʃən/, dysfunction /dɪsˈfʌŋk.ʃən/, fissure /ˈfɪʃ.ɚ/, flush /ˈflʌʃ/
- Uzun kelimeler — vurguyu doğru yere koyun: vasodilation /ˌvæ.sə(ʊ).daɪˈleɪ.ʃ(ə)n/, administer /ədˈmɪn.ɪ.stə/, hypertension /ˌhaɪ.pɚˈtɛn.ʃən/, coronary /ˈkɔɹənɛɹi/, hypovolemia /haɪpoʊvəˈliːmiə/
Türkçe konuşanların zorlandığı sesler:
- /w/ — dudaklar yuvarlak, /v/ değil: sublingual /sʌbˈlɪŋ.ɡwəl/, worsen /ˈwɝsn̩/, await /əˈweɪt/, swallow /ˈswɑ.loʊ/, warn /woɹn/
- Kelime başındaki ünsüz kümesi — araya ünlü eklemeyin: blocker /ˈblɑkɚ/, prescribe /pɹɪˈskɹaɪb/, flush /ˈflʌʃ/, breastfeed /ˈbɹɛs(t)fiːd/, clinician /klɪˈnɪʃən/
- /æ/ — “e”den daha açık: angina /ˈæn.d͡ʒɪ.nə/, vasodilation /ˌvæ.sə(ʊ).daɪˈleɪ.ʃ(ə)n/, hepatic /həˈpætɪk/, tachycardia /ˌtæk.ɪˈkɑː.di.ə/, lastly /ˈlæstli/
Bu videoyla nasıl çalışılır
- Videonun tamamını konuşmadan bir kez dinleyin ve bilmediğiniz kelimeleri not edin.
- Normal hızda cümle cümle tekrar edin; ritminiz konuşmacıyla aynı olana kadar her cümleyi yineleyin.
- Kendinizi kaydedin ve orijinaliyle karşılaştırın; nitrate, nitroglycerine, hypotension gibi kelimelere özellikle dikkat edin.
Gölgeleme Tekniği Nedir?
Gölgeleme, başlangıçta profesyonel tercüman eğitimi için geliştirilen ve çok dilli Dr. Alexander Arguelles tarafından popüler hale getirilen, bilim destekli bir dil öğrenme tekniğidir. Yöntem basit ama güçlüdür: ana dili İngilizce olan bir sesi dinler ve hemen yüksek sesle tekrar edersiniz — konuşmacıyı 1-2 saniye gecikmeyle takip eden bir gölge gibi. Pasif dinleme veya dilbilgisi alıştırmalarının aksine, gölgeleme beyninizi ve ağız kaslarınızı gerçek konuşma kalıplarını eşzamanlı olarak işlemeye ve yeniden üretmeye zorlar. Araştırmalar, telaffuz doğruluğu, tonlama, ritim, bağlı konuşma, dinleme anlama ve konuşma akıcılığını önemli ölçüde geliştirdiğini göstermektedir — bu da onu IELTS Konuşma hazırlığı ve gerçek dünya İngilizce iletişimi için en etkili yöntemlerden biri yapar.