ABGs Tic-Tac-Toe interpretation Method
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ABG Worksheet (Cheatsheet)
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Outline
Overview
- The ABG Tic Tac Toe method uses visual placement of values for evaluation.
Nursing Points
General
- Setup
- Three columns:
- Acidosis
- Normal
- Alkalosis
- Two rows under the headers
- Left blank
- Three columns:
- Process
- For each value, determine if it represents acidosis, alkalosis, or a normal value.
- Write “pH”, “pCO2” and HCO3” under their correct columns
- Whichever value is in the same column with pH is the source:
- pCO2 = Respiratory
- HCO3 = Metabolic
- Mixed Conditions
- All 3 values will be in the same column
- The extra one will be “off the charts”
- All 3 values will be in the same column
- Determining Compensation
- Fully Compensated
- If you have a normal pH and both pCO2 and HCO3 are abnormal under different columns, you will have ‘tic tac toe’ straight across
- Will NOT have any in the same column
- If you have a normal pH and both pCO2 and HCO3 are abnormal under different columns, you will have ‘tic tac toe’ straight across
- Partial Compensation
- If you have two in the same column (pH and one other), AND the other value is in the opposite column (NOT normal)
- The Normal column will be empty
- If you have two in the same column (pH and one other), AND the other value is in the opposite column (NOT normal)
- Fully Compensated
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Transcript
- What is the ABGs Tic Tac Toe method?
- The ABG Tic Tac Toe method uses visual placement of values for evaluation.
The next method for ABG interpretation is the Tic Tac Toe method. Now, I’ll be honest, this is my preferred method. But, make sure you’re trying all of the methods to figure out what makes sense to you and what works. Everyone has a different learning style, so these each cater to different types of learners.
This method, specifically, is very visual – it relies on visual placement of each value as acidosis, alkalosis, or normal.
So – I call this version 1. This is actually what I use personally, and you’ll even find a blank version in our ScrubCheats. Essentially you would put a star or a heart or a smiley face on the chart based on your results and see which ones match up. But as I was putting this lesson together, I realized that it’s not as easy to see compensation and it’s not as clear – and honestly, it’s really more like the physiology version – so I’m going to show you Tic Tac Toe version 2 and show you how quick and easy it is, and I think you’re going to love it!!
So in version 2, you will set up a little table that looks like this – three columns, acidosis, normal, and alkalosis. And you’ll have 2 rows. This is super easy to just jot at the top of a test paper or on your brain sheet in clinicals. As you do step 1 of interpretation, you’ll place each value in the box it corresponds to. So if your pH is acidotic, your PaCO2 is acidotic, and your bicarb is normal, you just write them in. Then, if you have two that match in a column, you automatically know that’s your source just by looking at it. So, step 2 basically takes no thought. This is a respiratory acidosis. Let’s work through some examples and we’ll look at compensation as we go.
Step 1 – pH is high, so it’s alkalosis – I’ll write pH in this box. PaCO2 is low, so it’s alkalosis – I’ll write PaCO2 in this box. Bicarb of 22, that’s normal, so I’ll write it under normal. Immediately, Step 2 is done – I see my source is the CO2 and therefore this is a Respiratory Alkalosis. Now, for step 3 – the first sign is that both the CO2 and bicarb are abnormal, right – but we can see that bicarb is normal, so there’s NO compensation. So this is an uncompensated respiratory alkalosis.
Let’s do another – step 1. pH 7.29 is acidotic, so put pH here. CO2 37 is normal, put CO2 here. Bicarb 16 is low, which is acidotic, put HCO3 here. So, right away we see that we have a metabolic acidosis. Step 3 – are both bicarb and CO2 abnormal? No, so this is an uncompensated metabolic acidosis. Now, one thing I want to show you is that you could also have a MIXED condition. Let’s say the CO2 was 47 – it would ALSO be acidosis, right? So I always say, you know you have a mixed condition if you have a level that’s off the charts – you basically have a double-whammy issue here.
Okay, let’s do another one. Step 1 – pH 7.32 is acidotic, CO2 55 is acidotic, bicarb 29 is alkalotic, because it’s high. So step 2 – we can see that we have a respiratory acidosis. Now, step 3 – is there compensation? Are both bicarb and CO2 abnormal? YES. pH is still abnormal so it’s only partially compensated. Here’s the trick – we know it’s a partially compensated condition if the normal column is completely empty. See it? So that’s the partial compensation trick.
Let’s look at our last one – you can probably guess what this one’s gonna be. Step 1 – pH 7.44 is normal. CO2 52 is acidosis. HCO3 35 is alkalosis. This is the one time I’ll skip to step 3 – here’s our trick – if you see a straight line ALL the way across, with a normal pH – you KNOW it’s fully compensated! So you just go back to that critical thinking to determine the source. Again, we just need to know which side of normal our pH is on – in this case, it’s leaning towards alkalosis, so it would be a fully compensated metabolic alkalosis.
So, again, this trick is very visual, but it makes it very quick and that’s why it’s my favorite. Grab the ABG fill in the blank again and use this trick to go through those problems. See if this is the best one for you! We even have some ABG-specific flashcards that you can check out. Some of them ask about the physiology, but there are also about a dozen interpretation cards in there! So make sure you check that out. Now, go out and be your best selves today. And, as always, happy nursing!!
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Hydrocephalus
Hypoxia – Signs and Symptoms (in Pediatrics) Nursing Mnemonic (FINES)
Ibuprofen (Motrin) Nursing Considerations
Immunizations (Vaccinations)
Imperforate Anus
Impetigo
Indomethacin (Indocin) Nursing Considerations
Influenza – Flu
Integumentary (Skin) Assessment
Intussusception
Intussusception for Certified Emergency Nursing (CEN)
Iron Deficiency Anemia
Isolation Precaution Types (PPE)
Isolation Precautions (MRSA, C. Difficile, Meningitis, Pertussis, Tuberculosis, Neutropenia)
Lactulose (Generlac) Nursing Considerations
Leukemia
Levels of Consciousness (LOC)
Levetiracetam (Keppra) Nursing Considerations
Lung Sounds
Marfan Syndrome
Meningitis
Meningitis Assessment Findings Nursing Mnemonic (FAN LIPS)
Meningitis for Certified Emergency Nursing (CEN)
Methylphenidate (Concerta) Nursing Considerations
Mixed (Cardiac) Heart Defects
Mumps
Nephroblastoma
Nephrotic Syndrome
Nephrotic Syndrome Case Study (Peds) (45 min)
Neuro Assessment
NSAIDs
Nursing Care Plan (NCP) for Acute Bronchitis
Nursing Care Plan (NCP) for Appendicitis
Nursing Care Plan (NCP) for Asthma
Nursing Care Plan (NCP) for Asthma / Childhood Asthma
Nursing Care Plan (NCP) for Attention Deficit Hyperactivity Disorder (ADHD)
Nursing Care Plan (NCP) for Bronchiolitis / Respiratory Syncytial Virus (RSV)
Nursing Care Plan (NCP) for Burn Injury (First, Second, Third degree)
Nursing Care Plan (NCP) for Celiac Disease
Nursing Care Plan (NCP) for Cerebral Palsy (CP)
Nursing Care Plan (NCP) for Cleft Lip / Cleft Palate
Nursing Care Plan (NCP) for Clubfoot
Nursing Care Plan (NCP) for Congenital Heart Defects
Nursing Care Plan (NCP) for Constipation / Encopresis
Nursing Care Plan (NCP) for Cystic Fibrosis
Nursing Care Plan (NCP) for Decreased Cardiac Output
Nursing Care Plan (NCP) for Dehydration & Fever
Nursing Care Plan (NCP) for Eczema (Infantile or Childhood) / Atopic Dermatitis
Nursing Care Plan (NCP) for Enuresis / Bedwetting
Nursing Care Plan (NCP) for Epiglottitis
Nursing Care Plan (NCP) for Fluid Volume Deficit
Nursing Care Plan (NCP) for Hemophilia
Nursing Care Plan (NCP) for Hydrocephalus
Nursing Care Plan (NCP) for Impaired Gas Exchange
Nursing Care Plan (NCP) for Imperforate Anus
Nursing Care Plan (NCP) for Impetigo
Nursing Care Plan (NCP) for Infective Conjunctivitis / Pink Eye
Nursing Care Plan (NCP) for Influenza
Nursing Care Plan (NCP) for Intussusception
Nursing Care Plan (NCP) for Marfan Syndrome
Nursing Care Plan (NCP) for Meningitis
Nursing Care Plan (NCP) for Mumps
Nursing Care Plan (NCP) for Neural Tube Defect, Spina Bifida
Nursing Care Plan (NCP) for Omphalocele
Nursing Care Plan (NCP) for Otitis Media / Acute Otitis Media (AOM)
Nursing Care Plan (NCP) for Pediculosis Capitis / Head Lice
Nursing Care Plan (NCP) for Pertussis / Whooping Cough
Nursing Care Plan (NCP) for Phenylketonuria (PKU)
Nursing Care Plan (NCP) for Reye’s Syndrome
Nursing Care Plan (NCP) for Rheumatic Fever
Nursing Care Plan (NCP) for Rubeola – Measles
Nursing Care Plan (NCP) for Scoliosis
Nursing Care Plan (NCP) for Sickle Cell Anemia
Nursing Care Plan (NCP) for Tonsillitis
Nursing Care Plan (NCP) for Varicella / Chickenpox
Nursing Care Plan (NCP) for Vomiting / Diarrhea
Nursing Care Plan for (NCP) Autism Spectrum Disorder
Nursing Case Study for Pediatric Asthma
Obstructive Heart (Cardiac) Defects
Ocular Infections (Conjunctivitis, Iritis) for Certified Emergency Nursing (CEN)
Omphalocele
Opioid Analgesics
Pancrelipase (Pancreaze) Nursing Considerations
Pediatric Bronchiolitis Labs
Pediatric Gastrointestinal Dysfunction – Diarrhea
Pediatric Oncology Basics
Pediatrics Course Introduction
Pediculosis Capitis
Pertussis – Whooping Cough
Phenylketonuria
Phenytoin (Dilantin) Nursing Considerations
Platelets (PLT) Lab Values
Pneumonia
Promotion and Evaluation of Normal Elimination Nursing Mnemonic (POOPER SCOOP)
Pulmonary Function Test
Red Blood Cell (RBC) Lab Values
Respiratory Acidosis (interpretation and nursing interventions)
Reye’s Syndrome
Reyes Syndrome Case Study (Peds) (45 min)
Rheumatic Fever
ROME – ABG (Arterial Blood Gas) Interpretation
Rubeola – Measles
Salmeterol (Serevent) Nursing Considerations
Scoliosis
Selegiline (Eldepyrl) Nursing Considerations
Sickle Cell Anemia
Spina Bifida – Neural Tube Defect (NTD)
Steroids – Side Effects Nursing Mnemonic (6 S’s)
Stoma Care (Colostomy bag)
Strabismus
Sudden Infant Death Syndrome (SIDS)
Sympathomimetics (Alpha (Clonodine) & Beta (Albuterol) Agonists)
Thorax and Lungs Assessment
Tonsillitis
Topical Medications
Tracheal Esophageal Fistula – Sign and Symptoms Nursing Mnemonic (The 3 C’s)
Transient Incontinence – Common Causes Nursing Mnemonic (P-DIAPERS)
Treatment of Sickle Cell Nursing Mnemonic (HOP to the hospital)
Umbilical Hernia
Vaccine-Preventable Diseases (Measles, Mumps, Pertussis, Chicken Pox, Diphtheria) for Certified Emergency Nursing (CEN)
Varicella – Chickenpox
Varicella Case Study (Peds) (30 min)
Vitals (VS) and Assessment
Vomiting
White Blood Cell (WBC) Lab Values
X-Ray (Xray)
ADLs (Activity of Daily Living) Nursing Mnemonic (BATTED)
Emotions and Motivation
Growth & Development Theories
Maslow’s Hierarchy of Needs in Nursing
Psychological Disorders
State of Consciousness
Stress and Crisis