Hepatitis B Antigen and Antibody
Hepatitis B Antigen and Antibody
SpecimenSerum (1 mL) collected in a gold-, red-, or red/gray-top tube. Place separated serum into a standard transport tube within 2 hr of collection.
Onset of HBV infection is usually insidious. Most children and half of infected adults are asymptomatic. During the acute phase of infection, symptoms range from mild to severe. Chronicity decreases with age. HBsAg and HBcAb tests are used to screen donated blood before transfusion. HBsAg testing is often part of the routine prenatal screen. Vaccination of infants, children, and young adults is becoming a standard of care and in some cases a requirement.
This procedure is contraindicated for
- Detect exposure to HBV
- Detect possible carrier status
- Pre- and postvaccination testing
- Routine prenatal testing
- Screen donated blood before transfusion
- Screen for individuals at high risk of exposure, such as hemodialysis patients, persons with multiple sex partners, persons with a history of other sexually transmitted diseases, IV drug abusers, infants born to infected mothers, individuals residing in long-term residential facilities or correctional facilities, recipients of blood- or plasma-derived products, allied health-care workers, and public service employees who come in contact with blood and blood products
Positive findings in:
- Patients currently infected with HBV
- Patients with a past HBV infection
- Drugs that may decrease HBeAb and HBsAb include interferon.
Nursing Implications and Procedure
Potential nursing problems
|Problem||Signs & Symptoms||Interventions|
|Fatigue (Related to decreased energy secondary to liver dysfunction associated with disease process and resulting inadequate absorption, metabolism and storage of nutrients)||Decreased concentration; increased physical complaints; unable to restore energy with sleep; reports being tired; unable to maintain normal routine||Assess for physical cause of fatigue; pace activities to preserve energy stores; rate fatigue on a numeric scale to trend degree of fatigue over time; identify what aggravates and decreases fatigue; assess for related emotional factors such as depression; evaluate current medications in relation to fatigue; assess for physiologic factors such as anemia|
|Knowledge (Related to new condition or diagnosis; lack of familiarity or understanding with disease and treatment)||Lack of interest or questions; multiple questions; anxiety in relation to disease process and management||Teach the process of disease transmission, sharing needles with infected persons, unprotected sex with an infected person, sharing blood or body fluid with an infected person, blood products from an infected person; assess the patient and family knowledge of disease, transmission, and treatment; assess for cultural, literacy, or vision and hearing concerns that would interfere with learning; explain that adequate nutrition and rest can prevent disease complications; demonstrate proper hand-washing technique with re-demonstration; emphasize vigilant hand washing; discuss the implications of the disease as related to future blood donations (not possible); discuss safe sex; explain that razors, toothbrushes, and other personal care items should not be shared; encourage family member to receive hepatitis vaccine; make patients aware that sexual partners should receive the hepatitis vaccine; explain that infected pregnant women can pass the disease to the child at birth|
|Infection (Related to unprotected sex; exposure to blood and body fluids of an infected person; sharing needles with an infected person)||Fever; fatigue; loss of appetite; jaundice; nausea and vomiting; dark-colored urine; abdominal pain; stool that is clay colored; joint pain; it is possible there will be no symptoms||Explain that the best treatment is adequate rest, good nutrition, and adequate fluid intake; recommend that family and significant others receive the hepatitis vaccination; explain that alcohol should be avoided to decrease risk of liver damage; explain that over-the-counter medication should be checked with the physician before taking to ensure there is no risk to the liver; explain that jaundice can last several months; administer prescribed medications|
|Activity (Related to inadequate nutrient metabolism; increased basal metabolic rate associated with viral infection)||Verbal report of weakness; inability to tolerate activity; shortness of breath with activity; altered heart rate, blood pressure, and respiratory rate with activity||Assess current level of physical activity; take baseline vital signs; trend vital signs with activity; assess response to activity; monitor for oxygen desaturation with activity; administer prescribed oxygen with activity; collaborate with physical therapy to support activity; monitor blood pressure for orthostatic changes; collaborate with the patient to establish activity goals and guidelines; pace activities to match energy stores; assist with self-care; monitor liver enzyme levels; encourage long, uninterrupted periods of rest; consider use of bedside commode; assist patient in setting realistic activity goals|
- Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
- Patient Teaching: Inform the patient this test can assist in evaluating for hepatitis infection.
- Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex.
- Obtain a history of the patient’s hepatobiliary and immune systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
- Obtain a history of IV drug use, high-risk sexual activity, or occupational exposure.
- Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values online at DavisPlus).
- Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
- Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
- Note that there are no food, fluid, or medication restrictions unless by medical direction.
- Potential complications: N/A
- Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
- Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
- Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
- Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
- Promptly transport the specimen to the laboratory for processing and analysis.
- Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
- Nutritional Considerations: Dietary recommendations may be indicated and will vary depending on the type and severity of the condition. Explain the importance of providing an adequate daily fluid intake of at least 4 L. Monitor the patient’s weight, intake, and output each day, and assess for development of ascites. Elimination of alcohol ingestion and a diet optimized for convalescence are commonly included in the treatment plan. As a general rule, small frequent meals that are high in carbohydrates and low in fat will provide the required energy while not burdening the inflamed liver.
- Cultural and Social Considerations: Recognize anxiety related to test results, and be supportive of impaired activity related to lack of neuromuscular control, perceived loss of independence, and fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to counseling services. Counsel the patient, as appropriate, regarding risk of transmission and proper prophylaxis. Stress the importance of hand hygiene to prevent transmission of the virus. Hepatitis B immune globulin (HBIG) vaccination should be given immediately after situations in which there is a potential for HBV exposure (e.g., accidental needle stick, perinatal period, sexual contact) for temporary, passive protection. Some studies have indicated that interferon alfa may be useful in the treatment of chronic hepatitis B.
- Counsel the patient and significant contacts, as appropriate, that HBIG immunization is available and has in fact become a requirement in many places as part of childhood immunization and employee health programs. Parents may choose to sign a waiver preventing their newborns from receiving the vaccine; they may choose not to vaccinate on the basis of philosophical, religious, or medical reasons. Vaccination regulations vary by state.
- Inform the patient that positive findings must be reported to local health department officials, who will question him or her regarding sexual partners.
- Cultural and Social Considerations: Offer support, as appropriate, to patients who may be the victims of rape or other forms of sexual assault, including children and elderly individuals. Educate the patient regarding access to counseling services. Provide a nonjudgmental, nonthreatening atmosphere for a discussion during which the risks of sexually transmitted diseases are explained. It is also important to discuss the problems that the patient may experience (e.g., guilt, depression, anger).
- Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.
- Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP.
- Provide information regarding vaccine-preventable diseases where indicated (e.g., hepatitis B).
- Provide contact information, if desired, for the Centers for Disease Control and Prevention (www.cdc.gov/vaccines/vpd-vac) and (www.cdc.gov/DiseasesConditions).
- Answer any questions or address any concerns voiced by the patient or family.
Expected Patient Outcomes
- States the importance of family members and sexual partners receiving hepatitis vaccine to protect against infection
- States the importance of using family or significant other to use personal protective equipment such as gloves to protect from infection and use good hand washing practices
- Family and significant other demonstrate the proper technique in the application and removal of gloves as personal protective equipment and hand washing
- Relates the importance of hepatitis vaccine immunization to family members and significant others, as well as sexual partners
- Complies with the request to abstain from alcohol use
- Complies with the request to rest prior to meals to increase appetite and calorie intake
- Related tests include ALT, ALP, antibodies, antimitochondrial, AST, bilirubin, biopsy liver, Chlamydia group antibody, cholangiography percutaneous transhepatic, culture anal, GGT, hepatitis C serology, HIV serology, liver and spleen scan, syphilis serology, and US liver.
- Refer to the Hepatobiliary and Immune systems tables at the end of the book for related tests by body system.