Hepatitis B Nursing NCLEX Review

This review covers hepatitis B for nursing students prepping for NCLEX. It breaks down the meaning of the disease, how it spreads, key signs and symptoms, diagnostic blood work, treatment options, pregnancy considerations, vaccine schedules, and essential patient education points.

For more GI nursing reviews check out these videos, and don’t forget to take the free hepatitis B quiz when you’re done reviewing the material.

What is Hepatitis B?

Hepatitis B refers to inflammation of the liver caused by the hepatitis B virus.

Breaking down the term:

Hepat- = liver
-itis = inflammation

So hepatitis means liver inflammation, and in this case it is caused by a viral infection: the hepatitis B virus.

Transmission of Hepatitis B

Hepatitis B is spread through exposure to infected bodily fluids.

• Main transmission routes include:
  • Sexual contact involving exchange of:
    • Semen
    • Vaginal fluids
    • Blood
  • During pregnancy and delivery (major risk during birth due to fluid exposure)
    • Rare transmission through the placenta (in utero)
  • Contaminated equipment such as:
    • Shared needles
    • Needle sticks in healthcare settings
    • Unclean medical equipment
    • Razors

Complications in Newborns

If a baby contracts hepatitis B, possible complications include:

• Long-term liver damage
• Growth and development problems
• Jaundice

Signs and Symptoms (HEPAT B Mnemonic)

• H – Hepatomegaly
• E – Enlarged liver due to inflammation
• P – Pale stools
  • Occurs due to bilirubin not properly reaching the stool
• A – Abdominal pain and tenderness
  • Especially in the right upper quadrant (RUQ) where the liver is located
• T – Tiredness
  • Extreme fatigue
• B – Bilirubin buildup (see the patho below)
  • Causes:
    • Jaundice (yellow skin and eyes)
    • Dark urine
    • Pale stools in severe cases

Bilirubin Explained

Bilirubin is produced from the breakdown of old red blood cells (about 120-day lifespan).

Normal process:

• RBCs break down = bilirubin forms
• Liver processes bilirubin
• Bilirubin is excreted into bile
• Bile goes to intestines → stool becomes brown

In hepatitis B: Liver cannot properly process bilirubin

• Bilirubin leaks into:
  • Skin = jaundice
  • Eyes = yellowing of sclera
  • Urine = dark color
  • Stool may become pale due to reduced bilirubin in the GI tract

Nursing Role: Screening and Blood Work

Pregnant patients:

• All pregnant patients should be tested each pregnancy
  • Test: hepatitis B surface antigen (HBsAg)
  • Positive = current infection
• Additional pregnancy screening recommendations:
  • Hepatitis C screening
  • Hepatitis A vaccine if risk factors are present
  • Hepatitis B vaccine if not previously vaccinated

All Patients:

Hepatitis B Serology (Triple Panel)

1. Hepatitis B Surface Antigen (HBsAg)
   Positive = currently infected
2. Hepatitis B Surface Antibody (HBsAb)
   Positive = immune or vaccinated
3. Hepatitis B Core Antibody (HBcAb)
   Positive = past/recovered infection

Key exam concepts:
Vaccinated patient should have what results if they have NEVER had an actual hepatitis B infection?
-HBsAb = positive
-HBcAb = negative
Vaccination exposes body to surface antigen = creates surface antibodies
No exposure to core antigen = core antibody remains negative

Treatment and Nursing Management

Post-exposure (non-immune, no prior vaccine):

• Hepatitis B immunoglobulin (HBIG) within 24 hours
• Start hepatitis B vaccine series

Acute hepatitis B (non-pregnant):

Supportive care:

• IV fluids
• Rest (supports liver healing)
• Antiemetics for nausea

Severe cases:

• Antiviral medications
• Monitor liver labs, including PT/INR
• Rising values indicate worsening clotting ability and liver dysfunction

Chronic hepatitis B:

First-line antivirals such as:

• tenofovir
• entecavir
• Goal:
  • Decrease viral load
  • Reduce infectivity
  • Prevent liver damage

Pregnancy Treatment Considerations

• Antivirals typically started at 28–32 weeks
• Goal: reduce viral load and prevent transmission to baby

Newborn management:

• Hepatitis B vaccine at birth
• Hepatitis B immunoglobulin at ~12 hours after birth
• Continue full vaccine series
  • Hepatitis B Vaccine Schedule (Children)
    • Birth
    • 2 months
    • 6–18 months
    • Note: CDC update in 2025- if mother is hepatitis B negative, birth dose may be delayed.

Patient Education (Hepatitis Mnemonic)

• Prevention and safety:
  • Hepatitis B vaccine is preventative
• Use condoms to reduce transmission risk (not 100% protective)
• Breastfeeding:
  • Allowed if baby receives:
    • Immunoglobulin within 12 hours of birth
    • Vaccine at birth

• H – Hand hygiene
  • Strict handwashing to prevent spread
• E – Eat low-fat, high-carb diet
  • Supports liver regeneration and digestion
• P – Personal items not shared
  • No sharing:
    • toothbrushes
    • razors
    • cups
    • utensils
    • towels
• A – Activity conservation
  • Rest promotes healing
• T – Toxic substances avoided
  • Avoid:
    • alcohol
    • sedatives
    • aspirin
    • acetaminophen
    • other hepatotoxic medications
• I – Isolation precautions
  • Avoid sharing bathrooms during infectious period
• T – Test result understanding
  • HBsAg = infection
  • HBsAb = immunity/recovery
  • HBcAb = past infection
• I – Immunoglobulin timing
  • Within 24 hours after exposure
  • Within 12 hours after birth (newborn)
• S – Small frequent meals
  • Helps manage nausea

Additional Nursing Teaching Points

• Additional Nursing Teaching Points
• Encourage rest to allow liver healing
• Avoid cooking for others while infectious
• Emphasize vaccination importance
• Monitor for fatigue and jaundice
• Maintain infection control precautions

You may be interested in: STI Comprehensive Quiz Questions

_References:

_{Centers for Disease Control and Prevention. (2016). The ABCs of hepatitis. https://www.cdc.gov/hepatitis/Resources/Professionals/PDFs/ABCTable.pdf}

_{Centers for Disease Control and Prevention. (2017). FastStats: Liver disease. https://www.cdc.gov/nchs/fastats/liver-disease.htm}