01.

03 ABG (Arterial Blood Gas)

Interpretation-ROME
Overview
1. Interpretation is all about determining the SOURCE of the abnormality

2. Three basic steps regardless of method

a. Determine acidosis, alkalosis, or normal:

i. pH
ii. CO2

iii. HCO3

b. Which is the source?

c. Is there compensation?

Nursing Points
General
1. ROME:

a. Respiratory Opposite
b. Metabolic Equal

Assessment
1. Respiratory Acidosis

a. pH ↓
b. pCO2 ↑

c. HCO3 (n)
2. Respiratory Alkalosis

a. pH ↑
b. pCO2 ↓

c. HCO3 (n)
3. Metabolic Acidosis

a. pH ↓

b. pCO2 (n)
c. HCO3 ↓

4. Metabolic Alkalosis

a. pH ↑

b. pCO2 (n)
c. HCO3 ↑
5. Compensation

a. If CO2 and HCO3 are BOTH abnormal in SAME direction

b. PARTIAL compensation if pH is abnormal

c. FULL compensation if pH is normal
6. Mixed

a. If CO2 and HCO3 are BOTH abnormal in DIFFERENT direction

 b. pH ABNORMAL
c. Typically will NOT see compensation
d. Need more information to determine ROOT cause

Examples
1. pH 7.52, pCO2 28, HCO3 25

a. pH ↑

b. pCO2 ↓
c. HCO3 (n)
d. Respiratory Alkalosis

i. NO Compensation
2. pH 7.3, pCO2 30, HCO3 18

a. pH ↓
b. pCO2 ↓
c. HCO3 ↓
d. Metabolic Acidosis

i. PARTIAL compensation
3. pH 7.44, pCO2 49, HCO3 33

a. pH (n – on the alk side)

b. pCO2 ↑
c. HCO3 ↑

d. Metabolic Alkalosis

i. FULL compensation
4. pH 7.29, pCO2 54, HCO3 20

a. pH ↓
b. pCO2 ↑

c. HCO3 ↓
d. MIXED Acidosis

i. Would need more information to determine ROOT Cause

Cornell Note-Taking System Instructions:

1. Record: During the lecture, use the note-taking column to record the lecture using telegraphic sentences.
2. Questions: As soon after class as possible, formulate questions based onthe notes in the right-hand column.
Writing questions helps to clarifymeanings, reveal relationships, establish continuity, and strengthenmemory.
Also, the writing of questions sets up a perfect stage for exam-studying later.
3. Recite: Cover the note-taking column with a sheet of paper. Then, looking at the questions or cue-words in the
question and cue column only, say aloud, in your own words, the answers to the questions, facts, or ideas
indicated by the cue-words.
4. Re ect: Re ect on the material by asking yourself questions, for example: “What’s the signi cance of these
facts? What principle are they based on? How can I apply them? How do they t in with what I already know?
What’s beyond them?
5. Review: Spend at least ten minutes every week reviewing all your previous notes. If you do, you’ll retain a
great deal for current use, as well as, for the exam.

For more information, visit www.nursing.com/cornell

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