Hepatitis B Vaccine, Symptoms, Treatment Nursing STI NCLEX Review

Ajouté : 2026-04-30

[00:00:00]Hey everyone, it's Nurse Sarah and in this review, I'm going to go over hepatitis B. And as always, whenever you get done watching this lecture, you can access a free quiz that will test you on this material you just learned. So, let's get started. To help us understand hepatitis B, let's take that word apart, hepatitis. So, we have a prefix of hepat, which means liver, and a suffix of itis, which means inflammation. So, whenever we take that and put that together, we get liver inflammation.

[00:00:26]But, what is actually causing our liver to get inflamed? Well, it's a pesky little virus known as the hepatitis B virus. It gets in there and it causes a lot of problems. Now, how can you get hepatitis B? Well, there's various ways.

[00:00:43]One way it's transmitted is sexually.

[00:00:45]So, having sexual contact with someone who has hepatitis B and you're exchanging bodily fluids such as semen, vaginal fluid, and blood can transmit it. It can also be transmitted during pregnancy. One of the main ways is through delivery because when that baby is born delivered, there's a lot of an exchange of those bodily fluids and the virus can be there and go to baby. In addition, it's rare, but it could be transmitted in utero the placenta.

[00:01:11]Now, some complications that could happen to the baby if they do contract hepatitis B is they can have long-term damage to their liver. Also, they can have growth and development problems and jaundice. And a little bit later in this lecture, we're going to talk about some treatment steps that can be taken to hopefully help prevent transmitting hepatitis B to that newborn if they are born to a mother who has hepatitis B.

[00:01:36]It can also be transmitted through contaminated devices such as sharing needles, even a needle stick if you got one as a healthcare provider and your patient had it, um unclean medical equipment, razors, etc. So, now let's talk about the signs and symptoms of hepatitis B. And to help you remember those, remember a mnemonic I created called hepat B. So, first up is our H, hepatomegaly. We know that hepat means liver, but whenever we throw on that megaly, that means abnormal enlargement of an organ and the organ we're talking about is the liver. So, all that inflammation is causing that liver to become enlarged and that's going to cause a lot of problems. In addition, extreme fatigue, pale stools, and here in a moment when I talk about bilirubin buildup, you'll understand why in severe cases they can have pale stools, abdominal pain and tenderness on palpation. And this is mainly going to be in that right upper quadrant. The reason for that is because that is where your liver lives. It likes to live up here in that right side in the upper part.

[00:02:39]So, then we have the last part, our bilirubin buildup. So, let's talk a moment about bilirubin. What is this?

[00:02:45]Well, this is a really cool substance that is created from the breakdown of old, tired, worn-out red blood cells in your body. Specifically, it comes from the heme of the hemoglobin. And we know that red blood cells live around 120 days. So, your body is doing this process and it's getting this bilirubin.

[00:03:08]So, that bilirubin's going to go to the liver. It's going to deal with majority of it.

[00:03:13]And we can't have this substance hanging out in our body, so it has to take it and put it somewhere. Main place it's going to go is it's going to go into the bile. And the bile is going to flow down through the bile ducts, which eventually is going to go to your small intestine your GI tract and it's going to end up in your stool. So, the reason that your stool has that nice brown color is because of the bilirubin that has been put there. And that in the end came from red blood cells. But, whenever we have a liver problem going on like with hepatitis, that bilirubin can't get there. So, instead, that bilirubin will start to leak in places it shouldn't. It'll go into the skin, the mucous membranes, which will cause your skin to have a yellowish-orangish color to it and you can really notice this in the whites of the eyes. Plus, some of that bilirubin will also go into the urine causing the urine to go from the nice pretty yellow color to a very deep dark color. Now, let's go over the nurse's role.

[00:04:19]Specifically, we're going to first talk about blood work and screening. And these guidelines are going to be based on CDC recommendations. So, first up, we're going to talk about the pregnant patient. It's currently recommended that all pregnant patients during each pregnancy be tested for hepatitis B. And it's going to be through some blood work that they're specifically going to be looking for the hepatitis B surface antigen. If this comes back positive, it means that they have a current infection. Now, one thing I want you to remember to help yourself on exams, as I go through these specific blood tests, you want to memorize what their meanings are. Like, if it's negative, what does that mean? If it's positive, what does that mean? Cuz that's where a lot of questions like to come.

[00:05:02]It's also recommended about the pregnant patient from the American College of Obstetricians and Gynecologists that not only do we screen for hepatitis B, but we also screen for hepatitis C.

[00:05:14]And they recommend administering a hepatitis A vaccine if the patient has risk factors or exposure factors. Also, administering the hepatitis B vaccine.

[00:05:26]It let's say if the patient's never been vaccinated before. Well, the patients have been through the childhood vaccines or they have a risk factor from exposure. Let's say they've never been vaccinated, but they have a risk factor, we definitely want to make sure that they get vaccinated.

[00:05:42]Now, one thing with the hepatitis C, you might be wondering, well, how about the vaccine for that? There's not currently a vaccine here in the US for that virus.

[00:05:50]Now, let's expand and talk about the non-pregnant patient. So, when are you going to test people who aren't pregnant for hepatitis B? Well, of course, if they've had any type of exposure. This could be an exposure through a workplace event or it could be through some type of sexual exposure. Let's say they've tested positive for another STI. Well, that increases their risk factor of potentially having hepatitis B. So, you'd want to just test them for that as well. Now, it's currently recommended that if a patient is 18 or older and they've never been screened for hepatitis B, that they should at least once be tested with the triple panel.

[00:06:24]So, what does that triple panel include?

[00:06:26]Well, we've already touched on the first one. It will look at the hepatitis B surface antigen. And if this comes back positive, what did it mean? That they are currently infected. So, they could transmit that virus to someone else.

[00:06:38]The other thing tested is the hepatitis B surface antibody. This will come back positive if a patient is immune or they've been vaccinated. And then lastly, we have the total antibody to the hepatitis B core antigen. And this will come back positive if the patient has had a past infection of the actual hepatitis B virus itself. So, one thing you want to maybe familiarize yourself with is a question that may come up is about, let's say you have a patient who's never had hepatitis B, but they've been vaccinated, which again, like I said earlier, a lot of people have through the childhood vaccines. So, how would you expect, let's say you check their hepatitis B surface antibody. How do you expect that to come back? If they really um got the vaccine and they got immunity to it through that vaccine, it should come back positive because in that vaccine, they're getting exposed to the surface antigens, which will cause them to make those surface antibodies.

[00:07:36]So, we expect that to be positive. But, how about their total antibody to the hepatitis B core antigen? What would we expect that to be if they've never had the actual virus, but they just got the vaccine? We would expect that to be negative because they weren't actually exposed to those core antigens, hence those core proteins from the virus. They were only exposed to the surface. So, we'd expect that to be negative. Now, let's switch gears and talk about the nurse's role specifically with treatment. So, first up, let's say we have a patient who's had a potential exposure to this virus and they've never been vaccinated and they're not immune. What can we do to hopefully decrease the risk of them actually getting the virus? Well, we can give them hepatitis B immune globulin, ideally within 24 hours of that exposure, and start the vaccine series.

[00:08:28]Now, what do we do for patients who aren't pregnant, but they have acute cases of hepatitis B? Well, that treatment's really going to revolve around supportive care and we'll get into a mnemonic a little bit later that'll help you remember a lot of that supportive care that we're going to do.

[00:08:44]But, that's going to revolve around IV fluids, helping them rest to help that liver regenerate and heal itself, and giving them antiemetics because a lot of times they're going to have severe nausea.

[00:08:56]But, we can have severe cases of hepatitis B. Whenever that occurs, patients typically going to be started on antivirals. We want to really monitor their lab work, specifically labs that's associated with the liver. Your liver plays a huge role with clotting factors.

[00:09:11]So, for instance, we can look at their PT/INR. That tells us how fast that blood is clotting. So, if that level is trending upward, that tells us that the clotting time is getting really prolonged and we're having a risk of patient possibly bleeding out and it's telling us our liver's not doing too good.

[00:09:29]In chronic cases, first line treatment is antivirals such as tenofovir or entecavir. And notice at the end of these names, they have VIR.

[00:09:40]That tips you off they're dealing with an antiviral. And what these medications are going to do is help decrease that viral count that will make them a little less infectious and prevent damage to that liver. Now, let's flip over to the patient who is pregnant. So, the whole goal is we want to really get that viral count down because if we can do that, it's going to prevent damage to the liver, also transmitting it to the baby.

[00:10:10]So, with this, they'll be starting on some antivirals typically anywhere between 28 to 32 weeks. Now, some other steps can be done. So, we have pregnant patient on our antivirals, but we have baby. We can help protect them.

[00:10:24]We can give them the hepatitis B vaccine at birth and start that hepatitis B immune globulin at about 12 hours of birth. And then, they want to continue with that vaccination series.

[00:10:39]So, let's go over this vaccination series. With this, you want to reme- memorize it because it's only going to help you for a word. These exams are just going to help you for your pediatric exams cuz you got to know that vaccine schedule.

[00:10:50]With the hepatitis B, it's going to be given in three series of children. It's going to be typically at birth, 2 months, and 6 to 18 months. However, one thing I want to note is that recently we had a CDC guideline change in 2025 that says that if the mom is negative for hepatitis B, that this birth vaccine for the hepatitis B can be delayed a little bit. So, just remember that. Now, let's wrap up this lecture and talk about patient education. So, first off, you want to educate your patient that there is a preventative vaccine that can help protect against this virus. Also, pregnant patients, they may be wondering, "Can I breastfeed if I have hepatitis?" And the answer to this is yes, if the baby has received the immune globulin and the vaccine within 12 hours after birth.

[00:11:37]You also want to stress the importance of using condoms that helps decrease the risk of transmission. It's not 100% going to decrease it, but it helps decrease it. In addition, there's some other things you want to include. And to help you remember that, remember this mnemonic I created called hepatitis.

[00:11:53]First is hand washing. You want to make sure that strict hand hygiene is implemented to prevent transmission.

[00:11:59]Also, the patient wants to eat low-fat, high-carb meals. This is going to support liver regeneration and compensates for that altered bile production. Helps with digestion. They also want to be mindful of personal hygiene products. So, they don't want to share toothbrushes, razors, drinking cups, utensils, towels, etc. And they want to implement activity conservation.

[00:12:19]So, encourage rest to allow that liver to heal. And avoid toxic substances like alcohol, sedatives, aspirins, acetaminophen, and other liver toxic over-the-counter and prescription medications. And it's best that they have individual bathrooms, especially while contagious. So, they want to avoid sharing bathrooms with others. It's important they are familiar with test results. For instance, again, that hepatitis B surface antigen that tells you you're infectious, the hepatitis B surface antibody that tells you you're recovered or immune, and then that total core hepatitis B antibody antigen that tells us that you've had a past infection. And remember that immune globulin can be given within 24 hours after an exposure that we talked about earlier, and then within 12 hours after birth for the baby. And then lastly, encourage small, frequent meals. That's going to help with the nausea. And the patient should not cook for others until they are non-infectious. Okay, so that wraps up this review over hepatitis.

[00:13:21]Now, if you want to learn more about the other types of hepatitis, I have a whole video where I compare all the different types. So, you can see their differences, or treatments, and etc.