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8-Step Guide to ABG Analysis: Tic-Tac-Toe

Method
TheeasiestmethodtointerpretABGs!

ByGilWayne,RN Jan21,2015

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An arterial blood gas (ABG) is a blood test that measures the acidity (pH) and the levels of oxygen
and carbon dioxide in the blood. Blood for an ABG test is taken from an artery whereas most other
blood tests are done on a sample of blood taken from a vein. This test is done to monitor several
conditions that can cause serious health complications especially to critically ill individuals.
Every day, a lot of nursing and medical students assigned in acute areas encounter ABG results,
which they may not necessarily be able to interpret with its knotty aspect. They struggle over the
interpretation of its measurements, but they are not especially complicated nor difficult if you
understand the basic physiology and have a step by step process to analyze and interpret them.
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There may be various tips and strategies to guide you, from mnemonics, to charts, to lectures, to
practice, but this article will tell you how to interpret ABGs in the easiest possible way. And once you
have finished reading this, youll be doing actual ABG analysis in the NCLEX with fun and excitement!
Here are the steps:

1.Knowthenormalvalues
Know the normal and abnormal ABG values when you review the lab reports. Theyre fairly easy to
remember: for pH, the normal value is 7.35 to 7.45; 35-45 for paCO2; and 22-26 for HCO3. Remember
also this diagram and note that paCO2 is really inverted for the purpose of this method.

2.DetermineifpHisunderacidosisoralkalosis
Next thing to do is to determine the acidity or alkalinity of the blood through the value of pH. The pH
level of a healthy human should be between 7.35 to 7.45. The human body is constantly striving to
keep pH in balance.
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pH level below 7.35 is acidosis

pH level above 7.45 is alkalosis

3.Determineifacidbaseisrespiratoryormetabolic
Next thing you need to determine is whether the acid base is Respiratory or Metabolic.
paCO2 = Respiratory
HCO3 = Metabolic

4.RememberROME
Still, it all boils down to mnemonics. The mnemonic RO-ME.
Respiratory Opposite
When pH is up, PaCO2 is down = Alkalosis
When pH is down, PaCO2 is up = Acidosis
Metabolic Equal
When pH is up, HCO3 is up = Alkalosis
When pH is down, HCO3 is down = Acidosis

5.TicTacToe
And yes, ABG problems can be solved work using the tic-tac-toe method. All you have to do is make a
blank chartsimilar to this:

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6.MarktheChart
Using the lab result values, mark them on your tic-tac-toe. Lets begin with this sample problem:
pH: 7.26, paCO2: 32, HCO3: 18
Using the normal values reference chart in the first step, determine where the values should be
under in the tic-tac-toe. In the given example, the solution is as follows:
pH of 7.26 is LOW = ACID so place pH under Acid
paCO2of 32 is LOW = BASE so place paCO2 under Base
HCO3of 18 is LOW = ACID so place HCO3 under Acid
Your chart should looklike this:

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7.Matchitup
In this step, determineat which column matches up with the pH. In the given example, HCO3 goes
with pH. HCO3 is considered Metabolic (shown in step 3), and both are under Acid, so this example
implies Metabolic Acidosis.

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8.Determinecompensation
The last step is to determine if the ABG is Compensated, Partially Compensated, or Uncompensated.
Heres the trick:
If pH is NORMAL, PaCO2 and HCO3 are both ABNORMAL = Compensated
If pH is ABNORMAL, PaCO2 and HCO3 are both ABNORMAL = Partially Compensated
If pH is ABNORMAL, PaCO2 or HCO3 is ABNORMAL = Uncompensated
Therefore this ABG is METABOLIC ACIDOSIS, PARTIALLY COMPENSATED .
By applying the steps above, interpret the following ABGs:
pH:7.44, PaCO2: 30, HCO3:21
pH is NORMAL = NORMAL so place pH under Normal
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PaCO2 is LOW = BASE so place PaCO2 under Base

HCO3 is LOW = ACID so place HCO3 under Acid
*Since the acidity of the blood is determined by the value of the pH, determine whether the normal
pH is SLIGHTLY ACIDIC or SLIGHTLY BASIC. In this example, pH is NORMAL but SLIGHTLY BASIC
therefore it is ALKALOSIS.
In this case PaCO2 goes with pH. PaCO2 is considered Respiratory (shown in step 3), and both are
under Basic, so this example implies Respiratory Alkalosis. The HCO3 is also abnormal. When pH is
NORMAL and PaCO2 and HCO3 are both ABNORMAL, it indicates FULL COMPENSATION.

Therefore this ABG is RESPIRATORY ALKALOSIS, FULLY COMPENSATED.

Try this problem next:
pH 7.1, PaCO2 40, HCO3 18
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pH is LOW = ACID so place pH under Acid

PaCO2 is NORMAL = NORMAL so place PaCO2 under Normal
HCO3 is LOW = ACID so place HCO3 under Acid
In this case HCO3 goes with pH. HCO3 is considered Metabolic (shown in step 3), and both are under
Acidic, so this example implies Metabolic Acidosis. The PaCO2 is normal. When pH is ABNORMAL, and
when either one of PaCO2 or HCO3 is ABNORMAL, it indicates UNCOMPENSATION.

Therefore this ABG is METABOLIC ACIDOSIS, UNCOMPENSATED.

Tryitoutwiththesequizzes
Want to try out the Tic-Tac-Toe method? Here are some sample ABG Analysis quizzes:

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ABG Analysis NCLEX Exam 1 (10 Items)

ABG Analysis NCLEX Exam 2 (10 Items)
ABG Analysis NCLEX Exam 3 (10 Items)

GilWayne,RN
http://nurseslabs.com

GilWayneisaregisterednurseandacontributoratNurseslabs.com.Preferswriting,travelinganddiscoveringstuffs.Nota
fanofworkinginahospital,butenjoysexploringnursingoutsideitswalls!Ilikethecolorgray,butcantimaginemyselfin
grayscrubs...lol!

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