SECONDARY PREVENTION

1. TOURNIQUET TEST OR RUMPEL-LEADS TEST.

This test measures the coaguability of the blood. This is done by applying a tourniquet on a
client’s extremity and observing the amount of petechiae produced. It is the presumptive test
for dengue, which is used to assess bleeding tendencies of a patient suspected to have the
disease. Before doing the test, the public health nurse must explain the procedure and purpose,
and he or she must assess the individual’s arm for petechaae, ecchymoses, or infections that
may affect the result. The tourniquet test is also contraindicated for individuals with fistula,
those with arteriovenous shunt, and those who have undergone a mastectomy.
2. CAPILLARY REFILL TEST OR NAIL BLANCH TEST.
Capillary refill is the rate where at which blood refills empty capillaries, it measures dehydration
and decreased peripheral perfusion for patient with dengue. It can be measured by holding a
hand higher than heart-level, then the soft pad of the thumb nail or toe nail is pressed until it
turns white or until blanching occurs. Pressure is then released and the time needed for the
color to return once pressure is released is measured. Normal refill time is more than 3 seconds
is a warning sign.
3. PLATELET COUNT AND HEMATOCRIT (HCT) TEST.
To confirm the diagnosis of dengue, a laboratory test such as platelet and hematocrit count
should be performed. A rapid decreased of platelet count in parallel in with a rising haematocrit
is a suggestive of progress to the critical phase of dengue. If no proper laboratory services are
available, the minimum standard is the point-of-care testing of haematocrit by capillary blood
sample with the use of a microcentrifuge.
4. HEMAGGLUTINATION-INHIBITITION (HI) TEST.
This test is frequently used for patients admitted in the hospital, as this test would require pair
sera. The HI test is based on the ability of dengue virus antibodies to inhibit agglutination.

TREAMENT

Treatment for dengue is symptomatic and supportive. Follow-up is also important for proper
observation and monitoring of patients.

 DENGUE FEVER
Give paracetamol every 6 hours, if the patient still has high fever do tepid sponge bath. DO NOT
give acetylsalicylic acid (aspirin), ibuprofen, or other nonsteroidal anti-inflammatory agents, as
these drugs may aggrevate bleeding.
 DEHYDRATION
Encourage oral intake of oral rehydration solution (ORS), fruit juices and other fluids containing
electrolytes and sugar to replace losses from fever and vomiting.
 HEMORRHAGE
Ensure strict bed rest and protect patient from trauma to reduce the risk of bleeding.
 NOSE BLEEDING
Maintain an elevated position and apply ice compress to promote vasoconstriction. If there is
gum bleeding, give ice chips, and advice the patient to use soft-bristled toothbrush. For
gastrointestinal bleeding place the patient on NPO. In case of shock, place patient in dorsal
recumbent position to promote circulation.
TERTIARY PREVENTION

 Continuity of 4’s
 Dengvaxia vaccine only to those individuals who experienced dengue is the only suitable for this
kind of vaccine.