Ateneo de Zamboanga University

College OF Nursing
PERFORMANCE EVALUATION CHECKLIST

TOURNIQUET TEST

NAME: ______________________________ DATE PERFORMED: _________________

YEAR & SECTION: ______________
Legend (Rating Criteria):
5 – Expert (student performs all tasks proficiently and independently).
4 – Competent (student performs efficiently in an effective and efficient manner).
3 – Progress Acceptable (performance is usually effective and but not always).
2 – Needs Improvement (progress in performance is too slow to judge satisfactorily; task performance
is not most of the time).
1 – Progress Unacceptable (no progress in performance has been demonstrated, and or performance
is consistently ineffective and inefficient).
Description:
 A tourniquet test determines capillary fragility. In a tourniquet test for dengue, the blood
capillaries are examined for their ability to withstand increased pressure. This gives a good
indicator for assessing the blood vessels and whether it will lead to Dengue Shock Syndrome
(DSS) or Dengue hemorrhagic Fever (DHF).
 This test involves checking what are known as petechiae, i.e. small red spots under the surface
of the skin. This petechiae are formed when blood leaks from capillaries into the skin.

Materials:
 Sphygmomanometer
 Stethoscope
PREPARATION 1 2 3 4 5
1. Explain the importance steps involved in the procedure.
2. Assemble the equipment.
3. Wash hands and observe infection control procedures.
Apply the sphygmomanometer over the mid-upper arm of the patient.
Measure the client’s blood pressure.
4.  You need the systolic BP (SBP) and the diastolic BP (DBP)to
determine the standard pressure for the Tourniquet test which is
the mean pressure (DBP+SBP divided by 2)
5. Release the pressure from the cuff.
Re-inflate the BP cuff slowly to the computed mean pressure and keep it
inflated in that pressure for 5 minutes.
6.
 This is very painful. Reassure the patient that this is normally felt
during the test.
Release the pressure and draw a one-inch sized square below the cuff on
7. the front surface of the forearm (antecubital area).
 1 inch is about the size of the last joint of the index finger.
8. Count the number of petechiae inside the square.
 If there are 20 or more- the test is positive
9. Document the findings.
TOTAL

___________________
Clinical
Instructor
(sign over printed name)