Skip to main content

Nursing Guide to Hepatitis A: Nursing Diagnosis, Interventions, & Care Plans

Reviewed By:

Updated On 10 Minute Read

Hepatitis A is an acute, self-limiting infectious condition of the liver caused by the hepatitis A virus (HAV), a non-enveloped RNA virus of the Picornaviridae family. Unlike chronic forms of hepatitis, such as hepatitis B or C, hepatitis A doesn’t lead to long-term liver damage or chronic infection.  

Transmission occurs primarily via the fecal-oral route, often through ingestion of contaminated food or water or close personal contact with an infected individual. This disease occurs worldwide but is especially common in regions with inadequate sanitation and limited access to safe, clean water. 

Although most cases resolve without complications, severe illness and fulminant hepatitis can occur, particularly in older adults and those with preexisting liver disease. Nursing care focuses on early recognition, supportive treatment, patient education, and infection control. 

Understanding Hepatitis Course

View Course

Etiology and epidemiology 

The hepatitis A virus (HAV) is highly contagious and transmitted primarily through the fecal-oral route. Once ingested, the virus enters the bloodstream through the epithelium of the oropharynx or intestinal tract, ultimately reaching the liver.  

In the liver, HAV replicates in hepatocytes and is then excreted in the bile, leading to high concentrations of the virus in the feces during the incubation period and early symptomatic phase. Because the virus is shed before symptom onset, asymptomatic individuals can unknowingly transmit the infection. 

Transmission is commonly associated with: 

  • Inadequate sanitation and hygiene practices, particularly in crowded or low-resource settings 
  • Consumption of raw or undercooked shellfish harvested from contaminated waters 
  • Ingestion of food or beverages handled by an infected person who did not perform proper hand hygiene 
  • Travel to areas with high HAV endemicity without prior immunization 
  • Close personal or sexual contact with an infected person, including household members and sexual partners 
  • Certain occupational risks, such as working in child care or food service 
  • Intravenous and non-injection drug use due to poor sanitary practices 

The Centers for Disease Control and Prevention (CDC) reports a substantial decline in hepatitis A cases in the U.S. following widespread implementation of childhood vaccination programs. Despite this, localized outbreaks have occurred in recent years, disproportionately affecting populations such as people experiencing homelessness and individuals affected by substance use. These outbreaks underscore the importance of targeted immunization strategies. 

Globally, hepatitis A remains a major public health concern in regions with inadequate water treatment and sewage disposal systems. The World Health Organization (WHO) estimates that 1.4 million instances of new infections occur annually, with children in highly endemic areas often acquiring immunity through early, often asymptomatic, exposure.  

However, as sanitation improves in transitional regions, populations may reach adulthood without exposure, increasing susceptibility to symptomatic disease and community-wide outbreaks. 

ICD-10 code 

The ICD-10-CM code for acute hepatitis A is B15.9 –—Hepatitis A without hepatic coma. Other relevant codes include: 

  • B15.0 — Hepatitis A with hepatic coma 

Assessment 

Assessment of hepatitis A begins with recognizing its clinical presentation, which often includes fatigue, fever, abdominal discomfort, jaundice, dark urine, and pale stools. These symptoms typically appear suddenly and are commonly preceded by flu-like complaints.  

A precise diagnosis requires a thorough review of the patient’s medical history combined with a detailed physical examination, and specific laboratory tests, most notably the detection of hepatitis A virus (HAV) IgM antibodies in the blood. A thorough assessment is essential not only for confirming the infection but also for guiding appropriate care and preventing transmission. 

Clinical presentation 

Typically, symptoms of hepatitis A appear two to six weeks after exposure and can include: 

  • Fatigue and malaise 
  • Nausea and vomiting 
  • Abdominal pain, particularly in the right upper quadrant 
  • Anorexia 
  • Low-grade fever 
  • Jaundice 
  • Dark urine and pale stools 
  • Pruritus (in some cases) 

Children under six years of age are often asymptomatic, while older children and adults are more likely to exhibit symptomatic diseases. The infectious period begins two weeks before symptom onset and extends up to one week after the onset of jaundice.  

Diagnostic tests 

  • Liver function tests (LFTs): These include measurements of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), which are typically elevated in hepatocellular injury. Total and direct bilirubin levels may rise, contributing to jaundice, while alkaline phosphatase levels may also be elevated due to intrahepatic cholestasis. Monitoring trends in LFTs helps assess the degree of liver inflammation and recovery. 
  • Anti-HAV IgM antibody test: This is the most specific test for diagnosing acute hepatitis A infection. IgM antibodies are detectable shortly before symptom onset and typically remain elevated for three to six months. A positive result confirms recent infection. 
  • Anti-HAV IgG antibody test: The presence of IgG antibodies indicates prior exposure to hepatitis A or immunity resulting from vaccination. Unlike IgM, IgG persists for life and provides long-term protection against reinfection. 
  • Prothrombin time (PT)/INR: These tests evaluate the liver’s ability to synthesize clotting factors and are crucial for identifying liver dysfunction severity. Prolongation of PT or elevation in INR may suggest impaired synthetic function and raise concern for fulminant hepatic failure, especially in hospitalized or high-risk patients. 

Management 

Management of hepatitis A primarily involves supportive care, as the infection is usually self-limiting and does not require antiviral treatment. The focus is on relieving symptoms, maintaining adequate hydration and nutrition, and ensuring liver function is supported during recovery.  

Medical treatment 

No specific antiviral treatment is currently recommended for hepatitis A. Management is supportive and directed at minimizing discomfort, maintaining physiological stability, and monitoring for potential complications. The clinical approach depends on the severity of symptoms and the presence of risk factors for severe diseases, such as older age or underlying liver conditions. 

  • Encourage bed rest during the acute phase to conserve energy and support immune system function. This is particularly important for patients experiencing profound fatigue or malaise. 
  • Maintain adequate hydration and electrolyte balance through oral fluids, or intravenous rehydration if oral intake is insufficient due to vomiting or anorexia. Monitor for signs of dehydration such as dry mucous membranes, hypotension, or tachycardia. 
  • Administer antiemetics as needed to control persistent nausea and vomiting, which can hinder nutritional intake and fluid balance. 
  • Monitor liver function through serial laboratory assessments, including liver enzymes, bilirubin levels, and coagulation profiles. Early identification of worsening hepatic function is critical. 
  • Avoid hepatotoxic substances, including alcohol, acetaminophen, and certain herbal supplements or medications. Patient education regarding safe medication use during recovery is essential. 
  • Encourage a well-balanced diet as tolerated. Although some clinicians recommend a low-fat diet for symptom relief, there is no strong evidence supporting dietary fat restriction in hepatitis A recovery.  

Hospitalization may be required for patients showing signs of clinical deterioration, including persistent vomiting, inability to maintain oral hydration, confusion or altered mental status (suggestive of hepatic encephalopathy), marked jaundice, or coagulopathy. Close inpatient monitoring allows for timely intervention and reduces the risk of progression to fulminant hepatic failure. 

Public health interventions 

  • Report confirmed cases to public health authorities to enable timely epidemiological tracking and public health response, including identification of common sources and prevention of broader community spread. Reporting supports contact tracing and facilitates the delivery of targeted post-exposure prophylaxis.   
  • Administer post-exposure prophylaxis with the hepatitis A vaccine or immune globulin (IG) within 14 days of exposure to unvaccinated individuals, especially household contacts, childcare center attendees and staff, food service workers, and healthcare personnel. IG is preferred for individuals under 12 months, immunocompromised persons, or those with chronic liver disease who may not respond optimally to vaccination.   
  • Promote vaccination for high-risk populations, including individuals affected by substance use, people experiencing homelessness, travelers to endemic regions, individuals with chronic liver conditions, and workers in environments with increased exposure risk such as sanitation and food handling. Outreach, education, and public health campaigns are essential for improving vaccine coverage and preventing future outbreaks.  
  • Those who work directly with food and are diagnosed with hepatitis A should be excluded from work until at least one week after the onset of jaundice or symptoms to prevent foodborne transmission. 

Nursing care plan 

A nursing care plan for hepatitis A focuses on supportive care and preventing the spread of this highly contagious viral infection. Since hepatitis A primarily affects the liver, nursing interventions aim to manage symptoms such as fatigue, nausea, and jaundice while promoting liver rest and recovery.  

Emphasis is placed on proper hygiene, patient education regarding transmission, and ensuring adequate nutrition and hydration. Through careful monitoring and targeted support, nurses help patients recover fully while minimizing the risk of further transmission to others. 

Nursing considerations 

Nurses caring for patients with hepatitis A must focus on comprehensive care that includes infection control, symptom management, patient comfort, emotional support, and education. Adhering to standard precautions such as proper hand hygiene and using personal protective equipment (PPE) is essential to preventing nosocomial transmission and protecting other patients and staff.  

Nurses should be vigilant in monitoring signs of clinical deterioration, such as worsening jaundice, confusion, or indications of dehydration, and respond promptly with appropriate interventions. 

Additionally, nurses are instrumental in case identification, documentation, and timely communication with public health authorities to aid in surveillance and containment. Beyond physical care, they support patients emotionally, addressing concerns about prognosis, isolation, and lifestyle adjustments.  

Nurses also guide patients through the recovery process by reinforcing the importance of follow-up care, medication safety, dietary modifications, and strict hygiene practices to prevent further spread of the virus. 

Assessment 

  • Monitor vital signs and general appearance. 
  • Assess for signs of dehydration, nausea, and poor intake. 
  • Evaluate skin and sclera for jaundice. 
  • Document changes in stool and urine color. 
  • Monitor lab values (LFTs, bilirubin, coagulation studies). 

Nursing diagnosis/risk for 

  • Risk for imbalanced fluid volume related to nausea and vomiting 
  • Acute pain related to hepatic inflammation 
  • Risk for impaired liver function 
  • Deficient knowledge related to disease transmission and prevention 
  • Risk for transmission of infection to others 

Interventions 

  • Administer prescribed medications (e.g., antiemetics) and monitor effects. 
  • Encourage oral fluid intake, and provide IV fluids as needed. 
  • Educate patients and caregivers about strict hand hygiene. 
  • Provide small, frequent meals to manage anorexia. 
  • Encourage rest and limit strenuous activities. 
  • Instruct on proper disposal of bodily waste and contaminated materials. 

Expected outcomes 

  • Patient maintains hydration and adequate nutritional intake. 
  • Patient demonstrates improved energy levels with rest. 
  • Patients and family verbalize understanding of transmission prevention. 
  • No secondary infections reported among household contacts. 
  • Liver function tests trend toward normal levels. 

Individual/caregiver education 

Patient and caregiver education is vital in preventing further transmission and ensuring a smooth recovery. Key points include: 

  • Importance of handwashing with soap and warm water, especially after using the bathroom and before and after food preparation 
  • Avoidance of food preparation for others during the contagious period (typically one to two weeks before symptom onset to a few days after onset of jaundice) 
  • Avoidance of alcohol and over-the-counter drugs that may stress the liver 
  • Recognition of warning signs that warrant medical attention (e.g., confusion, severe vomiting, signs of bleeding) 
  • Importance of follow-up visits and lab monitoring until liver function normalizes 
  • Encouragement to inform close contacts and follow recommendations for post-exposure prophylaxis 

FAQs

Resources 

References 

Paige Shoop Headshot

Paige Shoop, MSN, RN, CNOR

Paige Shoop, MSN, RN, CNOR, is a dedicated nurse leader with extensive experience in perioperative care, clinical coordination, and ambulatory operations. She currently serves as the Nurse Manager for the Urology Clinic at UAB Hospital, where she oversees a large, multidisciplinary team and leads initiatives to improve quality outcomes, streamline workflows, and enhance the patient experience. With a strong foundation in surgical and oncology nursing, she brings both clinical expertise and strategic insight to her leadership role. She has successfully implemented new procedural protocols, developed referral systems, and presented quality improvement work at national conferences. Shoop is actively involved in several professional and community organizations, including the Mike Slive Foundation Young Advisory Board and the Alabama Board of Nursing Leadership Institute.