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Know The Normal Values: Nclex
Know The Normal Values: Nclex
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.
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:
4. Remember ROME
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. Tic-Tac-Toe
And yes, ABG problems can be solved work using the tic-tac-toe method. All you have to do
is make a blank chart similar to this:
7. Match it up
In this step, determine at which column matches up with the pH. In the given example, HCO 3
goes with pH. HCO3 is considered Metabolic (shown in step 3), and both are under Acid, so
this example implies Metabolic Acidosis.
8. Determine compensation
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
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 HCO 3 is also
abnormal. When pH is NORMAL and PaCO2 and HCO3 are both ABNORMAL, it indicates
FULL COMPENSATION.
Usefulness
This method is simple, easy and can be used for the majority of ABGs. It only
addresses acid-base balance and considers just 3 values.
pH,
PaCO2
HCO3-
7.35-7.45
> 7.45
Acidosis
Normal or
Compensated
Alkalosis
< 35
35 -45
Tends
toward
alkalosis
Normal
or
> 45
Tends
toward
acidosis
Causes low
pH
Neutralizes
low pH
high pH
Low pH
Alkalosis
Acidosis
High
PaCO2
Metabolic
These steps will make more sense if we apply them to actual ABG values.
Click here to interpret some ABG values using these steps. You may want
to refer back to these steps (click on "linked" steps or use "BACK" button on
your browser) or print out this page for reference.
Remember, the first three steps apply to the majority of cases, but do
not take into account:
o the possibility of complete compensation, but those cases are
usually less serious, and