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Oct 11 2017

Tic Tac Toe Method Arterial Blood Gas (ABG) Interpretation for Nurses – Nursing Students #arterial

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Tic Tac Toe Method Arterial Blood Gas (ABG) Interpretation for Nurses Nursing Students

Didn t you love ABG problems in nursing school? Well, I didn t because I found them so confusing, and I could never remember if the value was acidotic or alkalosis. But then I found the TIC TAC TOE Method for ABGs and actually found solving ABG problems to be fun (like tic tac toe haha). Below I show you how to solve ABG problems using the Tic Tac Toe method.

After you read and watch the video on using the Tic Tac Toe Method, don t forget to that the ABG s practice quiz to test your knowledge.

In addition, you may be interested in:

Why Learn How to Interpret Arterial Blood Gases as Nurse?

Being able to interpret Arterial Blood Gases (ABGs) as a nurse is very important. Many new nurses feel they are not comfortable with interpreting Arterial Blood Gases after they graduate. Some of these nurses feel they will never use it in their job and feel it is the respiratory therapist s job or find it too confusing to understand.

However, as the nurse taking care of the patient with abnormal Arterial Blood Gases (ABGs) it is your responsibility to know what to report to the doctor and how to properly oxygenate your patient based on their ABGs.

For example, patient s with COPD are known as CO2 retainers and their pCO2 levels will be higher than someone who does not have COPD. However, patients with COPD can experience abnormally high pCO2 levels which can cause confusion, dizziness, unconsciousness, increased heart rate/blood pressure, etc. So it is very important the nurse knows how to interpret ABGS.

Luckily there is a super easy way to help you interpret ABGs and I want to share it with you below.

Easy Way on How to Interpret Arterial Blood Gases ABGs with Tic Tac Toe

First, we need to lay the foundation and talk about what three lab values you need to look at when trying to figure out ABGs, how to determine if that value is consider normal, an acid, or basic (alkalotic), and what fancy terms are used once the ABG is figured out.

Watch this video I made on how to use the TIC TAC TOE Method for solving Arterial Blood Gases. Don t forget to subscribe to my YouTube channel for more teaching videos.

Explanation Examples on Solving ABGs Problems

Below are the terms used to label abnormal ABG results:

  • Respiratory Acidosis (uncompensated, partially compensated, compensated)
  • Respiratory Alkalosis (uncompensated, partially compensated, compensated)
  • Metabolic Acidosis (uncompensated, partially compensated, compensated)
  • Metabolic Alkalosis (uncompensated, partially compensated, compensated)

When you are analyzing ABG results there are three things to look for when trying to find out if your patient is in respiratory or metabolic acidosis or alkalosis. Here they are and their normal numeric values:

  • pH: 7.35-7.45
  • CO2: 35-45 (CO2 lab value ALWAYS indicates a RESPIRATORY issue)
  • HCO3: 22-26 (HCO3 lab value ALWAYS indicates a METABOLIC issue)

Now to determine when these values are considered an acid or base. For pH anything less than 7.35 is an acid and anything greater than 7.45 is a base. For CO2 (NOTE: it is the opposite) anything less than 35 is a base and anything greater than 45 is an acid. For HCO3 anything less than 22 is an acid and anything greater than 26 is a base. Here is a guide to help you understand it:

In order to use the tic tac toe method you must first get a sheet of paper and set up a tic tac toe grid. Then label each column as acid , pH , and base . It should look like this:

Now lets solve a problem using the tic tac toe method: ABG results are the following ..pH7.24, PCO2 75, HCO3 28

  1. Draw your tic tac toe lay out.
  2. Analyze your pH. Ask yourself is it normal, basic, or acidic? Since the pH is less than 7.35 making it an acid, place it under the acid column.
  3. Analyze your PCO2. Ask yourself is it normal, basic, or acidic? Since the PCO2 is greater than 45 making it an acid, place it under the acid column along with pH. Remember PCO2 is the opposite and the normal is 35-45.
  4. Analyze your HCO3. Ask yourself is it normal, basic, or acidic? Since HCO3 is greater than 26 making it basic, place it under the base column because the value is considered basic.
  5. Your tic tac toe lay out should look like this:

Now that you have your tic tac toe grid set up. You need to figured out what you have. Since your pH is acidic you know that you have acidosis going on but is it respiratory or metabolic acidosis. Since CO2 represent respiratory and it is under the acid column with your pH you have respiratory acidosis going on.

But is it fully compensated, partially compensated, or uncompensated respiratory acidosis? Look at your HCO3! Since your HCO3 is under basic, the metabolic system is trying to balance the body s system out by becoming basic so it is partially compensating. So the answer is Partially Compensated Respiratory Acidosis. Note: If HCO3 was under the normal column it would not be trying to compensated and therefore it would be considered uncompensated respiratory acidosis.

Let s try another one: ABG results are: pH 7.50, PCO2 36, HCO3 32. Here is what your tic tac toe grid should look like:

  1. Analyze your pH. Ask yourself is it normal, basic, or acidic? Since the pH is greater than 7.45 making it a basic, place it under the base column.
  2. Analyze your PCO2. Ask yourself is it normal, basic, or acidic? Since the PCO2 is between 35-45 it is normal, place it under the normal column.
  3. Analyze your HCO3. Ask yourself is it normal, basic, or acidic? Since HCO3 is greater than 26 making it basic, place it under the base column because the value is considered basic.
  4. Since your pH is basic you know you have some alkalosis going on. But is it respiratory or metabolic? Since the HCO3 (which represents metabolic) is under you basic column with pH it is a metabolic issue. So your patient is in: Metabolic Alkalosis.
  5. Now is it fully compensated, partially compensated, or uncompensated metabolic alkalosis? Look at the CO2! Since it is under the normal column that means the CO2 has NOT tried to help out the body s system by making itself acidic. So the body is not compensating.
  6. Answer: Uncompensated Metabolic Alkalosis

ABG Practice Quiz

Do you want to see how well you know how to interpret ABGs? Here is a free ABG practice test .

Still Need More Help

Video this video tutorial:

Need More Help Interpreting ABGs for nursing school exams or a nice pocket guide to have as a reference when you need it on the job or at school. There is a great pocket guide reference available through Amazon.com called Arterial Blood Gas (ABG) Pocket Guide by Dana Oakes. It comes with an instructional guide as well. Here is what it looks like:





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