Ex Utero Intrapartum Treatment

(EXIT) Procedure
Operating Room/Post Anesthesia Care Unit
Calalang, Justine Nicolai, RN, MAN
Del Mando-Supan, Kareen Wristle, RN. MSN
Fajardo, Kristine, RN
Rivera, Dennis, RN, USRN
Ticsay, Anna Patricia, RN
Introduction
The Ex Utero Intrapartum Treatment (EXIT)
procedure is performed to improve the survival
rate during delivery of fetuses with life-
threatening airway obstructions.

The EXIT procedure is performed immediately

before the complete delivery of the baby and
placental separation, while the uteroplacental
circulation remains intact.
 Cystic Hygroma

TCystic hygromas are benign tumors that

appear as a fluid-filled sac, often forming on
a newborn’s neck.

The cyst forms because of the lymphatic

system blockage, which causes the fluid to
build up under their skin.

These cysts can be life-threatening and could

lead to miscarriage or stillbirth.
Objectives
At the end of this case presentation, the Preoperative, Intraoperative,
and Post-operative nurses will identify and prioritize at least three (3)
Nursing Care Problems and their Nursing Care Plan

Age:
Sex:
Allergies:
Pathologies:
Demographic Profile
Mother Baby
Age: 29 years old Age: Newborn
Date of Birth: November Date of Birth: May 19, 2023
09, 1993 Place of Birth: City of San Fernando,
Pampanga
Place of Birth: Angeles City
Gender: Male
Gender: Female
Civil Status: Single
Civil Status: Married
Address: Angeles City, Pampanga
Religion: Roman Nationality: Filipino
Catholic Date Admitted: May 19, 2023
Occupation: Housewife Admitting Diagnosis: Cystic Hygroma
Address: Angeles
City, Pampanga
Nationality: Filipino
History of Present Illness
March 18, 2023 (Ultrasound)
- single, live, intrauterine pregnancy
- Cephalic presenation
- 26 3/7 weeks by biometry
- placenta is anteriorly located, high
lying, grade I
- high normal amniotic fluid volume
- there is multicystic mass measuring
8.9 x 8.7 x 5.6cm at the anterior neck
area extending until the lower portion
of the face
- cervix appears closed
April 03, 2023 (Ultrasound)
- single, live, intrauterine pregnancy
- Cephalic presenation
- 29 5/7 weeks by biometry
- placenta is anteriorly located, high
lying, grade II
- high normal amniotic fluid volume
- there is multicystic mass measuring
9.1 x 9.5 x 7.9cm at the anterior neck
area extending until the lower portion
of the face
Social History
Mother Father
Diet: More on fruits and Diet: More on fruits and
vegetables vegetables
Exercise: Seldom Exercise: Seldom
Sleep and Rest: Adequate Sleep and Rest: Adequate
Cigarette Use: No Cigarette Use 5 sticks per day
Substance Use: No (long time ago)
Family Relationship: Good Substance Use: No
Friendship: Good Family Relationship: Good
Friendship: Good
Diagnostic and Laboratory Tests
DATE NAME OF INVESTIGATION DONE PATIENT VALUE NORMAL VALUE INFERENCE

4-3-2023 Ultrasonography 27th weeks AOG, (+) Anterior Neck Mass No Anomalies To determine the size and location of the mass
9.1x9.5x7.9cm

5-18-2023 BLOOD TYPING B+

HBsAg (rapid) Non-reactive Non-reactive Normal
Syphilis Non-reactive Non-reactive Normal

5-18-23 CBC
Hemoglobin 103 g/L 120-160 g/L Anemia
Hematocrit 0.32 0.37 – 0.47 Anemia
RBC 3.4 x10^9/L 4.0 – 5.4 Anemia
WBC 11.6 x10^9/L 4.0 – 10.0 Present infection
Prothrombin Time 12.7 seconds 11 – 16 seconds Normal Clotting Time

Partial thromboplastin time 28.2 seconds 28 – 40 seconds Normal PTT

Creatinine 57 umol/L 44 – 80 umol/L Normal Kidney function

Na 137.60 mmol/L 136 – 145 mmol/L Normal Sodium level

K 3.5 mmol/L 3.5 – 5.1 mmol/L Normal Potassium level

5-18-2023 URINALYSIS
Color Yellow Pale yellow to Amber Normal

Transparency Slightly Hazy Light Yellow Sign of UTI

Sugar None None Normal
Protein None None Normal
RBC 29.60/uL 0.0 – 11.0/uL Bladder / Urinary / Kidney Problem

WBC 33.20/uL 0.0 – 17.0/ uL Present Infection

5-18-2023 Rapid Antigen Test Negative Negative Normal

5-18-2023 Cardio Tocograph

Fetal Heart Rate 140 – 160 bpm 120 – 160 bpm Normal FHR
Contractions Every 4-5 minutes 5 – 10 minutes apart Normal Contractions
Lasting 30 – 70 seconds
Lasting 60 seconds
Diagnostic and Laboratory Tests
Diagnostic and Laboratory Tests
Diagnostic and Laboratory Tests
ASSESSMENT NURSING DIAGNOSIS SCIENTIIFIC EXPLANATION
Subjective: Anxiety related to situation of Anxiety is an emotion
“Kakarug ku” as verbalized by the upcoming newborn characterized by feelings of
the patient. secondary to operative tension, worried thoughts and
“ali ku mipatudtud” procedure physical changes like
increased blood pressure and
heart rate.
Vague theory, feeling of
Objective: discomfort or dread
 Poor eye contact accompanied by an
 Irritability autonomic response (the
source after non- specific or
unknown to the individual). A
feeling of apprehension of
danger. It is an altering signal
that warns of impending
danger and enables the
individual to take measures to
deal with threat.
PLANNING
After 8 hours shift the patient
will appear relaxed and able
to rest appropriately
After 8hours of nursing
intervention the patient will
acknowledge feelings and
identify ways to deal with the
anxiety.
INTERVENTION EXPECTED OUTCOME
Identify client’s perception of The patient was able to relax
the threat represented by the and understand the upcoming
situation newborn and the surgical
procedure
Establish a therapeutic
relationship, conveying GOAL MET
empathy and unconditional
positive regard
Provide for non-threatening,
consistent
environment/atmosphere,
minimize stimuli
Monitor physical response,
palpitations, rapid pulse,
repetitive movements, pacing
Provide accurate information
about the situation. Helps the
patient to identify what’s
reality base
Provide preoperative
education regarding the
procedure to be done
Administer anti-anxiety
medications as ordered.
ASSESSMENT NURSING DIAGNOSIS SCIENTIIFIC EXPLANATION PLANNING INTERVETION EXPECTED OUTCOME
Subjective: Acute Pain related to post A surgical incision to an After 1 hour of nursing Perform pain assessment The patient was able to
“Masakit ya ing tahi ku” operative incision unpleasant sensory and intervention the patient each time pain occurs, identify relaxation
as verbalized by the emotional experience will be relieved from pain investigate changes from technique to relieved pain
patient since there is damage in previous reports
the tissue. After 2 hours of nursing Pain scale from 8/10 to
intervention the patient Assess patient description 4/10
Sensory receptors in the will be able to identify of pain, acknowledge the
skin sent a signal via the relaxation technique and pain experience and GOAL MET
Objective: nerve fibers to the spinal diversional activities to convey acceptance of
 Pain Scale 8/10 cord and brainstem to the relieve from pain patient response to pain
 Guarding sign brain where the sensation
 Facial grimace of pain is perceived After 2 hours of nursing Monitor vital signs- usually
intervention the patient altered in acute pain
will become comfortable
moving with tolerable Provide calm and quiet
pain environment

Provide comfort (change

in position)

Adequate rest periods

Instruct to focus on one

image/object for
relaxation

Administered pain
medication as ordered
ASSESSMENT NURSING DIAGNOSIS SCIENTIIFIC PLANNING INTERVENTION EXPECTED OUTCOME
EXPLANATION
Subjective: Risk for fluid volume Post-partum hemorrhage After 4 hours of nursing Monitor intake and The patient was able to
“Bisa kung minum deficit related to low is defined as blood loss intervention the patient output maintain good uterine
danum” as verbalized by transverse cesarean from the uterus more will be able to maintain contractility and minimal
the patient section secondary to post- than 500ml within 24- fluid volume at a Monitor vital signs vaginal bleeding
partum bleeding hour period. It may be functional level as changes (hypotension,
immediate or late evidence by: tachypnea, tachycardia) GOAL MET
occurring from the first 24 - adequate Hgb, Hct,
RISK FOR BLEEDING hours of delivery Laboratory Result Assess uterine contraction
Objective: - good uterine and vaginal discharge
 Blood loss of 500ml contractility every hour
 Minimal Vaginal - good skin turgor,
Bleeding capillary refill Maintain on bed rest to
- stable vital signs provide undisturbed rest
period
ASSESSMENT NURSING DIAGNOSIS SCIENTIIFIC EXPLANATION PLANNING INTERVENTION EXPECTED OUTCOME

Subjective: Risk for infection related to Damage tissue (surgical site) After 10 minutes of nursing Encourage patient to observe The patient was able to
--- surgical site incision intervention the patient will good hygiene understand causative factors
be able to understand that may contribute to
causative factors that may Monitor patient for proper infection
contribute to infection hand washing technique
At risk for being invaded by The patient was able to
Objective: pathogenic organisms After 10 minutes of nursing Maintain sterile technique demonstrate and identify
 Surgical site incision intervention, the patient will for invasive procedure techniques in preventing
be able to demonstrate infection
techniques in preventing Encourage early ambulation,
infection after operation deep breathing, coughing, GOAL MET
Risk for infection position changes for good
circulation

Administer antibiotics as
ordered

Emphasize necessity of
taking antibiotics
(inappropriate use of
antibiotics can lead to drug
resistant and secondary
infection)