hey everyone this is sarah with register nurse RN comm and today i want to be talking to you about the tic-tac-toe method and how to use it when solving arterial blood gas problems in nursing school you'll be required to learn arterial blood gas values and how to interpret that based on those values for instance is a patient having respiratory alkalosis or they have a metabolic alkalosis and you have to be able to differentiate between those two and also you'll have to know whether the patient's trying to compensate or if they're partially compensated so in nursing school i remember having to solve these problems and these problems gave me a lot of difficulty but then someone showed me how to use the tic-tac-toe method so in this video i want to show you what the tic-tac-toe methods about how they actually set up a problem with it and talk to you a little bit about pH levels H c3o levels and things like that in the next video video we're actually going to work these ABG problems so be sure to check out that next video and work the videos along with me and then after that check out the free quiz we have on our website register nurse orange comm and test your knowledge on ABG's along with other in clicks quizzes and personality quizzes that we have so first let's talk about the tic-tac-toe method and how to use it with ABG's first the very first thing you want to learn before you start solving ADG problems is you need to learn the normal values because in a problem you'll be given the pH level you'll be given the pco2 level and you'll be giving given the hco3 level so you need to know what the normal ranges are for people so here are the normal ranges I would write this down pH level the normal is 7.35 to 7.45 anything over seven point four five is a base another word for base is alkalotic which is alkalosis anything less than seven point three five is an acid so it'd be acidotic I'm going to skip two hco3 because it's the same um 22 to 26 is your normal range for that and that represents metabolic so anything Oh 26 would be basic it would be alkalotic just like with the pH and anything less than 22 would be an acid so be alcoholic so they would be having a metabolic problem and they would be alcoholic I mean acidotic okay for the pco2 this represents your respiratory level and it's the opposite for what the pH and the hco3 are this a lot of times throws people off so just remember pco2 is opposite in a represent your respiratory so for instance anything less than 35 is basic so it's alkalotic anything over 45 is acidotic so it's an acid so you'll want to memorize these values because this is your baseline for whenever you're comparing your problem that you're given to how to set up the problem so I would write that down like I said before you actually start working your problems next let's go over the actual setting up for the tic-tac-toe method as you see this looks like a basic little tic-tac-toe you know whenever you used to play with your friends you would set up the tic-tac-toe like that and someone would be OHS another person would be exes and you would play like this and oh you got chick tac toe we're not really using the X's and O's we're going to throw that concept out but we are keeping the concept of lining something up with threes and in a row of threes so for a grid for the tic-tac-toe grid we've automatically going to put acid normal base and this is easy how it set up anything for the pH or the hco3 and remember anything that's less than the normal value is an acid and anything greater than that value is a base except for respiratory remember paco2 is the opposite so let's just work a problem so you can see exactly what I'm talking about okay in this problem the patient's pH is seven point two three there paco2 which represents respiratory is 50 and their hco3 is 30 and remember hco3 represents metabolic okay after you've set up your tic-tac-toe you wrote acid normal and base up at the top you're going to look at your ph it's 7.3 so remember normal pH is 7.35 to 7.45 so it's seven point two three so that would make it an acid so under acid we're going to write pH okay now we're going to look at paco2 and remember that represents respiratory it's fifty and looking at our normal paco2 if normals are thirty-five to forty five so since it's fifty remember it's the opposite for a respiratory it is an ass it's going to be an acid not a base it's an acid so our paco2 is f it ik so under that we're going to put paco2 and always solve your problem before you start doing your crosses because we need to know how our metabolic fits into this because this is going to tell us if we're compensating or not so always put all your values in before you cross down in your three letters so the hco3 is 30 normal hco3 is 22 to 26 so it's 30 so because it's greater than 26 its basic so there alkalotic so under base we're going to write HC 0 3 now we already have our tic-tac-toe and looking at this you know that this patient because we have three in a row this is where you're going to interpret if it's respiratory or metabolic paco2 what does it represent respiratory so we know that we have a respiratory issue now for instance let me just throw this out here if these two values were switched say hco3 was over here and paco2 was under base because we got the cross underneath here that would be a metabolic problem instead of a respiratory problem so we have respiratory problem now we have to decide are we alkalotic or acidotic very easy underneath on our grid we know it's an acid we have respiratory acidosis next thing we have to determine is this patient compensating or are they uncompensated they are partially compensated and this is how I know that because the body is trying to compensate the metabolic value is thrown off so it's not normal so they're partially compensating now if her hco3 was normal say it was 25 because remember 22 to 26 is normal this 25 would be under the normal range the body's not doing anything to try to help balance it out out because your body's always trying to do homeostasis and do a balancing act because if it was under normal it would be and it would be uncompensated but because the body's trying to correct itself and throw the metabolic rate off its partially compensated so your answer to that question would be respiratory acidosis partially compensated now in my next video on how to actually work these problems we get a little bit more in depth we talk about all the disorders and if they're compensated uncompensated using the tic-tac-toe method it's very easy and will help you on NCLEX help you on how to see your eighty eyes on how to just solve these problems so thank you so much for watching I hope you liked this video if you did please give it a thumbs up and be sure to visit registered nurse or en comm we have a lot of free in clicks and quizzes personality quizzes abd quizzes care plans everything you need to help you in nursing school and after nursing school so thank you so much for watching and have a great day