NUR 660 Week 12 Discussion 1 Case Study Discussion Team C: Hepatitis B and Cirrhosis

NUR 660 Week 12 Discussion 1 Case Study Discussion Team C: Hepatitis B and Cirrhosis

Describe the pathophysiology of acute hepatitis B infection. How is this different from chronic hepatitis B infection?

            Hepatitis is a group of different viruses that attack the liver cells called hepatocytes. In hepatitis B, the cells become damaged through a cell-mediated immune response to the virus. The antigens of this virus include HBcAg, HBeAg, and HBsAg. Recognizing these antigens in the blood is important for diagnosis and further monitoring the course of Hepatitis B.  If these antigens continually stay in the blood, especially HBsAg, then the individual is at a higher risk of chronic hepatitis B. If the antigens rise and then fall, it is most likely acute (Hubert & VanMeter, 2018, p. 461).

If J.B. had known about his exposure at the time, could any treatment measures have been undertaken at the time?

            There is no direct treatment that can fully destroy the virus even in the early stages. However, immune therapy (Gamma globulin) can be given to boost the patient’s immune system and help fight the disease. This treatment works best if given immediately, within 7-14 days of exposure.

Describe two signs of the preicteric stage and three signs of the icteric stage of acute hepatitis B infection. In which of the stages could J.B. transmit the virus? Be sure to include discussion of the mode of transmission.

            Acute hepatitis has three stages: preicteric, icteric, and posticteric. The first stage, preicteric, is subtle may only show signs of elevated AST/ALT (liver enzymes), fever, and muscle aches (Hubert & VanMeter, 2018, p. 462). When the inflammation of the liver persists, the bile duct becomes blocked and leads to a backup of waste including bilirubin. The following phase, the icteric stage, is marked by jaundice due to the increase in bilirubin. Three common signs of the icteric stage include light colored stools, dark urine, and itchy skin (Hubert & VanMeter, 2018, p. 462). J.B. can transmit the virus from the preinteric stage even if asymptomatic. It can be transmitted through blood and other body fluids. Examples of transmission include birth, sex, drug use through a needle, sharing toothbrushes & razors, various medical equipment, or hemodialysis (CDC, 2020).

What serum markers remain high when chronic hepatitis B is present?

            HBsAg is a hallmark serum marker of hepatitis. If this antigen consistently remains in the blood after six months, it implies chronic hepatitis B. The presence of anti-HBc is also another marker of chronic infection (Hubert & VanMeter, 2018, p. 462)..

Explain how cirrhosis develops from chronic hepatitis B. Why is the early stage of cirrhosis relatively asymptomatic?

            In chronic hepatitis B, the hepatocytes are constantly being inflamed leading to necrosis. As these cells die, fibrous scar tissue forms on the liver leading to obstruction and decreased blood supply causing permanent damage and cirrhosis. The early stages are often asymptomatic and may only have vague mild signs of fatigue, anorexia, weight loss, and diarrhea (Hubert & VanMeter, 2018, p. 458).

Explain why each of the following events occur: (1) excessive bleeding from trauma, (2) increased serum ammonia levels, and (3) hand-flapping tremors and confusion.

            As the liver becomes cirrhotic, its function severely decreases. It cannot produce enough clotting factors or absorb and store iron and vitamin B12 leading to anemia and increased bleeding. Ammonia is a waste product of protein and is metabolized by the liver to be further excreted by the kidneys in urine. When the cirrhotic liver cannot remove the waste, ammonia builds up in the blood causing hepatic encephalopathy leading to muscle twitching and confusion (Eberhardt & Topka, 2017).

Important information for writing discussion questions and participation

Welcome to class

Hello class and welcome to the class and I will be your instructor for this course. This is a -week course and requires a lot of time commitment, organization, and a high level of dedication. Please use the class syllabus to guide you through all the assignments required for the course. I have also attached the classroom policies to this announcement to know your expectations for this course. Please review this document carefully and ask me any questions if you do. You could email me at any time or send me a message via the “message” icon in halo if you need to contact me. I check my email regularly, so you should get a response within 24 hours. If you have not heard from me within 24 hours and need to contact me urgently, please send a follow up text to

I strongly encourage that you do not wait until the very last minute to complete your assignments. Your assignments in weeks 4 and 5 require early planning as you would need to present a teaching plan and interview a community health provider. I advise you look at the requirements for these assignments at the beginning of the course and plan accordingly. I have posted the YouTube link that explains all the class assignments in detail. It is required that you watch this 32-minute video as the assignments from week 3 through 5 require that you follow the instructions to the letter to succeed. Failure to complete these assignments according to instructions might lead to a zero. After watching the video, please schedule a one-on-one with me to discuss your topic for your project by the second week of class. Use this link to schedule a 15-minute session. Please, call me at the time of your appointment on my number. Please note that I will NOT call you.

Please, be advised I do NOT accept any assignments by email. If you are having technical issues with uploading an assignment, contact the technical department and inform me of the issue. If you have any issues that would prevent you from getting your assignments to me by the deadline, please inform me to request a possible extension. Note that working fulltime or overtime is no excuse for late assignments. There is a 5%-point deduction for every day your assignment is late. This only applies to approved extensions. Late assignments will not be accepted.

If you think you would be needing accommodations due to any reasons, please contact the appropriate department to request accommodations.

Plagiarism is highly prohibited. Please ensure you are citing your sources correctly using APA 7th edition. All assignments including discussion posts should be formatted in APA with the appropriate spacing, font, margin, and indents. Any papers not well formatted would be returned back to you, hence, I advise you review APA formatting style. I have attached a sample paper in APA format and will also post sample discussion responses in subsequent announcements.

Your initial discussion post should be a minimum of 200 words and response posts should be a minimum of 150 words. Be advised that I grade based on quality and not necessarily the number of words you post. A minimum of TWO references should be used for your initial post. For your response post, you do not need references as personal experiences would count as response posts. If you however cite anything from the literature for your response post, it is required that you cite your reference. You should include a minimum of THREE references for papers in this course. Please note that references should be no more than 5 years old except recommended as a resource for the class. Furthermore, for each discussion board question, you need ONE initial substantive response and TWO substantive responses to either your classmates or your instructor for a total of THREE responses. There are TWO discussion questions each week, hence, you need a total minimum of SIX discussion posts for each week. I usually post a discussion question each week. You could also respond to these as it would count towards your required SIX discussion posts for the week.

I understand this is a lot of information to cover in 5 weeks, however, the Bible says in Philippians 4:13 that we can do all things through Christ that strengthens us. Even in times like this, we are encouraged by God’s word that we have that ability in us to succeed with His strength. I pray that each and every one of you receives strength for this course and life generally as we navigate through this pandemic that is shaking our world today. Relax and enjoy the course!

Hi Class,

Please read through the following information on writing a Discussion question response and participation posts.

Contact me if you have any questions.

Important information on Writing a Discussion Question

• Your response needs to be a minimum of 150 words (not including your list of references)
• There needs to be at least TWO references with ONE being a peer reviewed professional journal article.
• Include in-text citations in your response
• Do not include quotes—instead summarize and paraphrase the information
• Follow APA-7th edition
• Points will be deducted if the above is not followed

Participation –replies to your classmates or instructor

• A minimum of 6 responses per week, on at least 3 days of the week.
• Each response needs at least ONE reference with citations—best if it is a peer reviewed journal article
• Each response needs to be at least 75 words in length (does not include your list of references)
• Responses need to be substantive by bringing information to the discussion or further enhance the discussion. Responses of “I agree” or “great post” does not count for the word count.
• Follow APA 7th edition
• Points will be deducted if the above is not followed

• Remember to use and follow APA-7th edition for all weekly assignments, discussion questions, and participation points.
• Here are some helpful links
• The is a great resource

Resources:

Centers for Disease Control and Prevention (CDC). (2020, July 28). Hepatitis B Questions and Answers for Health Professionals.

Eberhardt, O., & Topka, H. (2017). Myoclonic Disorders. Brain sciences, 7(8), 103. https://doi.org/10.3390/brainsci7080103

Hubert, R. J., & VanMeter, K. C. (2018). Pathophysiology Online for Gould’s Pathophysiology for the Health Professions(6th ed.). Elsevier

Team C: Hepatitis B and Cirrhosis

You are caring for J.B., age 35, who has had chronic hepatitis B for nine years. The origin of his acute infection was never ascertained. He is not married, lives alone, and sometimes has trouble managing his disease.

• Describe the pathophysiology of acute hepatitis B infection. How is this different from chronic hepatitis B infection?
• If J.B. had known about his exposure at the time, could any treatment measures have been undertaken at the time?
• Describe two signs of the preicteric stage and three signs of the icteric stage of acute hepatitis B infection. In which of the stages could J.B. transmit the virus? Be sure to include discussion of the mode of transmission.
• What serum markers remain high when chronic hepatitis B is present?
• Explain how cirrhosis develops from chronic hepatitis B. Why is the early stage of cirrhosis relatively asymptomatic?

J.B.’s cirrhosis is now well advanced. He has developed ascites, edema in the legs and feet, and esophageal varices. His appetite is poor, he is fatigued, and he has frequent respiratory and skin infections. Jaundice is noticeable. He has been admitted with hematemesis and shock resulting from ruptured esophageal varices.

• Explain why each of the following events occur: (1) excessive bleeding from trauma, (2) increased serum ammonia levels, and (3) hand-flapping tremors and confusion.

Posting to the Discussion Forum

1. Highlight and copy your assigned question from the list.
2. Select Reply.
3. Select Advanced.
4. Delete the subject line from the subject line field.
5. Type your assigned question number (e.g. “Question # 1”) into the subject line field.
6. Paste your assigned question into the reply text field.
7. Create your response.
8. Select Post when completed.

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