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ABGs Tic-Tac-Toe interpretation Method

ABGs Tic-Tac-Toe interpretation Method

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10 ABGs Tic-Tac-Toe interpretation Method NCLEX Questions

Question 1 of 10

A nurse is caring for a client who requires a mechanical ventilator for breathing assistance. The nurse checks the client’s routine ABG values and notes: pH 7.51, pCO2 32 mmHg, HCO3 24 mEq/L. These laboratory values best represent which of the following?

Metabolic alkalosis

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Question 2 of 10

A client presents to the emergency room with CNS depression due to narcotic overdose. The ABG results are as follows: pH 7.35, pCO2 48, HCO3 35. The nurse knows that the client is experiencing which of the following?

Fully compensated metabolic acidosis

Fully compensated respiratory acidosis

Partially compensated respiratory acidosis

Partially compensated metabolic acidosis

Question 3 of 10

A nurse is caring for a client who is recovering from a chest injury. The provider orders arterial blood gases for the client. The results are pH 7.26, pCO2 52 mmHg, HCO3 25 mmHg, and oxygen saturation 92 percent. Which of the following best describes this client’s condition?

Respiratory alkalosis

Metabolic alkalosis

Respiratory acidosis

Metabolic acidosis

Question 4 of 10

The nurse is caring for a client in renal failure. The nurse analyzes the client’s arterial blood gas values and concludes that the client is in metabolic alkalosis. Which of the following is a potential reason for this? Select all that apply.

The client's kidneys cannot retain HCO3

The client's kidneys cannot excrete sodium and bicarbonate

The client's kidneys cannot excrete acidic toxins

The client's kidneys cannot retain potassium and hydrogen

The client's kidneys cannot excrete ketones

Question 5 of 10

A client’s ABG results are the following: pH 7.3, pCO2 37, HCO3 18. The client is experiencing which scenario?

Metabolic alkalosis

Respiratory acidosis

Respiratory alkalosis

Metabolic acidosis

Question 6 of 10

A client is in respiratory alkalosis. The nurse knows that which of the following is a potential cause? Select all that apply.

Mechanical ventilation

Dehydration

Fever

Antacid overdose

Hypoventilation

Question 7 of 10

The nurse is caring for a client with cyclical vomiting. The client’s arterial blood gas (ABG) results are as follows: pH 7.48, pCO2 38, HCO3 27. The nurse knows the client is experiencing which of the following?

Metabolic alkalosis

Metabolic acidosis

Respiratory acidosis

Respiratory alkalosis

Question 8 of 10

A nurse is caring for a client with a diagnosis of respiratory alkalosis. Which pH finding would be consistent with this diagnosis?

7.49

7.35

7.45

7.29

Question 9 of 10

The nurse is evaluating the following ABG results: pH 7.3, PaCO2 38, HCO3 20. Which of the following is most likely occurring?

Nasogastric tube suction

Diarrhea

Hyperventilation

Airway obstruction

Question 10 of 10

The nurse is caring for a client with a bowel obstruction with a nasogastric tube that has been set to low wall intermittent suction for 3 days. The nurse should anticipate the development of which acid-base imbalance?

Respiratory acidosis

Metabolic acidosis

Metabolic alkalosis

Respiratory alkalosis

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Outline

Overview

The ABG Tic Tac Toe method uses visual placement of values for evaluation.

Nursing Points

General

Setup
1. Three columns:
  1. Acidosis
  2. Normal
  3. Alkalosis
2. Two rows under the headers
  1. Left blank
Process
1. For each value, determine if it represents acidosis, alkalosis, or a normal value.
2. Write “pH”, “pCO2” and HCO3” under their correct columns
3. Whichever value is in the same column with pH is the source:
  1. pCO2 = Respiratory
  2. HCO3 = Metabolic
5. Mixed Conditions
  1. All 3 values will be in the same column
    1. The extra one will be “off the charts”
Determining Compensation
1. Fully Compensated
  1. If you have a normal pH and both pCO2 and HCO3 are abnormal under different columns, you will have ‘tic tac toe’ straight across
    1. Will NOT have any in the same column
2. Partial Compensation
  1. If you have two in the same column (pH and one other), AND the other value is in the opposite column (NOT normal)
    1. The Normal column will be empty

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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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Concepts Covered:

Study Plan Lessons

Medical Terminology Course Introduction

Pharmacology Course Introduction

12 Points to Answering Pharmacology Questions

12 Points to Answering Pharmacology Questions

01.01 CCRN Test Overview for CCRN Review

MedTerm Basic Word Structure

54 Common Medication Prefixes and Suffixes

54 Common Medication Prefixes and Suffixes

MedTerm Body as a Whole

MedTerm Suffixes

Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)

Therapeutic Drug Levels (Digoxin, Lithium, Theophylline, Phenytoin)

Essential NCLEX Meds by Class

Essential NCLEX Meds by Class

MedTerm Prefixes

6 Rights of Medication Administration

6 Rights of Medication Administration

Pharmacodynamics

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The SOCK Method – Overview

The SOCK Method – S

The SOCK Method – S

The SOCK Method – O

The SOCK Method – O

The SOCK Method – C

The SOCK Method – C

The SOCK Method – K

The SOCK Method – K

Basics of Calculations

Basics of Calculations

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Neuro Terminology

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Dimensional Analysis Nursing (Dosage Calculations/Med Math)

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IV Infusions (Solutions)

IV Infusions (Solutions)

Urinary Terminology

Complex Calculations (Dosage Calculations/Med Math)

Complex Calculations (Dosage Calculations/Med Math)

02.06 Heart Murmurs for CCRN Review

Reproductive Terminology

Interactive Pharmacology Practice

Musculoskeletal Terminology

02.07 Reading “A, C, V Waves” & PAWP Waveforms for CCRN Review

02.08 Cardiac Catheterization & Acute Coronary Syndrome for CCRN Review

Interactive Practice Drip Calculations

Metabolic & Endocrine Terminology

02.09 12 Lead EKG- Leads 1, 2, 3, aVL, and aVF for CCRN Review

Hematology Oncology & Immunology Terminology

Pediatric Dosage Calculations

02.10 12 Lead EKG- Lead V1-V6 for CCRN Review

Integumentary (Skin) Terminology

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02.12 Myocardial Infarction- Inferior Wall for CCRN Review

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02.17 Septic Shock for CCRN Review

02.18 Cardiovascular Practice Questions for CCRN Review

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Benzodiazepines

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05.02 Liver Overview and Disease for CCRN Review

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06.01 Organ Failure, Dysfunction & Trauma for CCRN Review

NG Tube Medication Administration

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Anticonvulsants

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07.06 Increased Intracranial Pressure (ICP) for CCRN Review

07.07 Cerebral Perfusion Pressure for CCRN Review

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08.01 Psychological Review for CCRN Review

09.01 Acute Renal Failure Overview for CCRN Review

Antidiabetic Agents

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09.04 Continuous Renal Replacement Therapy for CCRN Review

09.05 Chronic Renal Failure for CCRN Review

09.06 Renal Practice Questions for CCRN Review

Insulin – Mixtures (70/30)

10.01 Arterial Blood Gas (ABG) Interpretation for CCRN Review

Histamine 1 Receptor Blockers

Histamine 1 Receptor Blockers

10.02 Breath Sounds for CCRN Review

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Histamine 2 Receptor Blockers

Histamine 2 Receptor Blockers

10.04 Pulmonary Question Review for CCRN Review

Renin Angiotensin Aldosterone System

Renin Angiotensin Aldosterone System

Sympatholytics (Alpha & Beta Blockers)

ACE (angiotensin-converting enzyme) Inhibitors

ACE (angiotensin-converting enzyme) Inhibitors

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ABG (Arterial Blood Gas) Interpretation-The Basics

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ABGs Tic-Tac-Toe interpretation Method

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Continue with Apple