The nurse is assessing a patient's arterial waveform and notes a notch on the descending portion of the waveform. Which of the following does this finding suggest to the nurse?
1. the highest systolic pressure
2. closure of the aortic valve and beginning ventricular diastole
3. systolic ejection of blood
4. the diastolic pressure
2
Rationale: The arterial waveform has a characteristic morphology that is related to the cardiac cycle. When the aortic valve opens, blood is ejected into the aorta. This forms a steep upstroke on the arterial waveform, called the anacrotic limb. The top of this limb represents the peak, or highest systolic pressure. After this peak pressure, the waveform descends. This descent forms the dicrotic limb and represents systolic ejection of blood that is continuing at a reduced force. The descending, or dicrotic, limb is disrupted by the dicrotic notch which represents closure of the aortic valve and the beginning of ventricular diastole. The lowest portion of the waveform represents the diastolic pressure and is reflected digitally on the monitor.
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