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Hepatitis B Nursing Guide

The content was created/revised by Kim Matthews, RN

Hepatitis B Overview

This course is intended as a Quick Reference for Hepatitis B and will cover an overview as well as nursing considerations utilizing the nursing process. 

Hepatitis B Etiology and Epidemiology

Hepatitis B causes inflammation of the liver and is caused by contact and subsequent infection with the hepatitis B virus. Hepatitis B is spread through blood, semen, or other body fluids from an infected individual. This can happen by sharing needles, from mother to baby during pregnancy, labor, or nursing, or having unprotected vaginal, anal, or oral sex (Centers for Disease Control and Prevention [CDC], 2020).

Hepatitis B can be a short-term illness, or it may become a chronic infection that can lead to cirrhosis or liver cancer. Acute hepatitis B occurs within the first 6 months after being exposed. The risk for chronic illness is related to age at time of infection. The younger an individual is when infected, the greater the chance for developing chronic illness.

The incubation period for acute hepatitis B can vary from 6 weeks to 6 months. Some individuals with acute hepatitis B may not show any symptoms. There are three phases of acute illness including:

  • Prodrome
  • Icteric
  • Convalescence

Those that experience symptoms in the prodrome phase may present with:

  • Malaise
  • Low-grade fever
  • Aversion to food
  • Fatigue
  • Joint/muscle pain
  • Nausea
  • Vomiting
  • Mild itching

During the icteric phase the individual may have:

  • Dark urine
  • Yellow eyes
  • Light colored stool

During the icteric phase, the prodromal symptoms improve. These phases may last a few days to a few weeks.

The convalescence phase is the gradual recovery period (World Health Organization, 2016). Even if individuals do not show symptoms, they are able to unknowingly spread the virus to others (Hepatitis B Foundation, 2021).

Diagnosing Hepatitis B

A diagnosis of hepatitis B cannot be made by examination only. There are multiple blood tests available that can not only diagnose hepatitis B but determine if it is acute or chronic. A blood test is also available to determine if someone is immune to hepatitis B (Mayo Clinic, 2020). A liver ultrasound and biopsy may be performed to assess the amount of liver damage.

Management Patients with Hepatitis B

The best treatment for hepatitis B is prevention through the hepatitis B vaccine. If an individual has been exposed to the virus and their vaccination status is unknown, an immunoglobin injection should be given within 12 hours of exposure. This treatment only provides short-term protection from showing symptoms, so the individual should also receive the vaccine.

The majority of individuals with acute hepatitis B resolve the infection spontaneously and may not need any treatment. Rest, proper nutrition, and plenty of fluids may be all that is needed. In more severe cases, antiviral medications may be given to prevent complications.

The American Association for the Study of Liver Disease (2018) recommends various antiviral medications for the treatment of chronic hepatitis B including:

  • Tenofovir alafenamide or TAF (Biktarvy®)
  • Entecavir (Baraclude®)
  • Tenofovir disoproxil fumarate or TDF (Viread®) (also used for prevention of transmission from mother-to-child)

If an individual is not on an antiviral, routine liver enzyme blood tests should be completed along with possible liver biopsies to assess for fibrosis and inflammation.

Hepatitis B Nursing Care Plan

Nursing Considerations

Use the nursing process to develop a plan of care for individuals. The nursing assessment (with common findings listed), diagnoses, interventions, expected outcomes, and education for hepatitis B are listed below.

Hepatitis B Assessment

The individual with acute hepatitis B may present with:

  • Dehydration
  • Hepatomegaly
  • Jaundice

Chronic hepatitis may include the same assessment findings as acute hepatitis along with:

  • Ascites
  • Atrophy of testicles
  • Peripheral edema
  • Signs of caput medusae (collateral veins in the abdomen)
  • Variceal bleeding

Nursing Diagnosis/Risk Assessment

There are a multitude of nursing diagnoses that may be necessary for the individual with hepatitis B. Some possible nursing diagnoses include:

  • Activity intolerance
  • Risk for infection
  • Alteration in fluid balance
  • Altered nutrition less than body requirements
  • Alteration in pain
  • Anxiety
  • Fatigue
  • Knowledge deficit

Hepatitis B Interventions

Nursing interventions will vary among individuals. Some of the most common nursing interventions include:

  • Educate individual on ways to conserve energy.
  • Use infection control techniques to prevent infection.
  • Assess for signs and symptoms of infection.
  • Perform lab tests to assess for fluid balance and liver function.
  • Assess vital signs, peripheral pulses, capillary refill, skin turgor, and mucous membranes.
  • Check for ascites or edema. Measure abdominal girth as indicated.
  • Observe for signs of bleeding including hematuria, melena, and ecchymosis.
  • Provide IV fluids as ordered.
  • Monitor dietary intake and caloric count.
  • Suggest small frequent meals.
  • Consult with dietician.
  • Medications and IV fluids as ordered
  • Assess level of understanding of the disease process, expectations and prognosis, and possible treatment options.
  • Provide education.

Expected Outcomes

Full recovery of presenting symptoms should be the goal. Individuals should be able to verbalize understanding of chronic disease and carrier state. The individual should also be aware of the importance of follow-up treatments.

Patient/Caregiver Education

The individual with hepatitis B and their household should be vaccinated for hepatitis B. Education should include proper preventative practices to avoid the transmission of disease to others. They should be educated on ways of virus transmission and that transmission is possible even when asymptomatic.

The individual and caregivers should be educated on the disease process, treatment plans, and responsibilities. Activity should be as tolerated with energy conservation techniques used.

Certain medications such as acetaminophen (Tylenol®) should be avoided due to the potential for liver toxicity. The individual should be educated not to take any medication or drugs unless approved by their healthcare provider. Alcohol should also be avoided.

A registered dietitian should be involved in providing education regarding fluid intake, nutritional needs, and possible vitamin supplement needs.

The healthcare provider should be notified of any signs and symptoms of recurrent disease or worsening of current disease. Refer the individual to support groups for people with liver disease.

Understanding Hepatitis

This course provides administrative and nursing professionals with an overview of viral hepatitis.

View Course

Additional Information

Content Release Date

6/10/2024

Content Expiration

12/31/2025

Course Contributor

The content for this course was created/revised by Kim Matthews, RN.

Ms. Matthews obtained a nursing degree from Western Kentucky University in 1998. Ms. Matthews possesses over 20 years of nursing experience with over 17 of those in the Skilled Nursing industry. Ms. Matthews has extensive experience in MDS, restorative nursing programs, and nursing management. Ms. Matthews is currently Post-Acute Care Content writer and subject matter expert for MDS.

References

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