SYMPTOMATOLOGY

FACTOR PRESENCE RATIONALE JUSTIFICATION

Tachypnea PRESENT Tachypnea is a normal
response to hypoxemia.
Tachypnea is most usually the
response to respiratory
acidosis or hypoxemia of acute
infection or the attempt to
restore pH balance during
metabolic acidosis most
especially in diabetes.
Additionally, tachypnea can
result from primary cardiac
abnormalities like
hypertension (Park, 2005).

Dyspnea PRESENT The most common symptom

associated with pleural
effusion is dyspnea which is
caused by airflow obstruction
which is secondary to airways
inflammation, airways
remodeling and sputum
hypersecretion; reduced lung
elastic recoil and the
obstruction of small airways
result in incomplete air
expelling and dynamic
hyperinflation or air trapping
(O'Donnell & Webb, 2005).
Chest Pain PRESENT When the heart muscles do not
receive enough oxygenated
blood, chest pain can occur. A
blockage in the coronary
arteries can lead to ischemia,
which also leads to chest pain
(American Heart Association,
2015).

Cyanosis PRESENT Accumulation of fluid in the

lungs impairs gas exchange
and decreases the ability of the
lungs to oxygenate blood. This
results in the hemoglobin in
red blood cells to leave the
 pulmonary circulation without
getting fully oxygenated. This
then results in cyanosis
(Grossman & Porth, 2014).

Fatigue and PRESENT With a decrease in stroke

Body volume, the cardiac output
Weakness decreases as well. With an
inadequate cardiac output, the
body is unable to respond to
increased energy demands.
This leads to fatigue and
activity intolerance. In
addition to fatigue, the
increased effort in breathing
leads to an increase in the
expenditure of energy, leading
to fatigue (Hinkle & Cheever,
2018). High blood glucose
makes the blood “sludgy”;
slowing circulation so cells
can’t get the oxygen and
nutrients they need. In
addition, high blood glucose
can cause diabetes fatigue
through inflammation. Blood
vessels get inflamed by the
sugar. When this happens,
according to research, immune
cells called monocytes come
into the brain, causing fatigue
(Spero, 2018).

Peripheral PRESENT Edema refers to swollen ankles

Edema and feet. It occurs when
certain tissue in the body gets
filled by fluid. The cause
behind this can be anything
from eating salty food to
maintaining a single sitting
position for long. Other factors
including hormonal changes
and diabetes can also lead to
swelling feet and ankles. In the
case of diabetes, you get the
 condition, due to factors
associated with it including
obesity, cardiovascular
problems, kidney disease, poor
blood circulation (India
Lifestyle, 2020).
Anasarca ABSENT An elevation of the right-sided
pressure leads to fluid
accumulation in the systemic
venous circulation. This causes
venous congestion and can
manifest as generalized edema
or anasarca (Hammer &
McPhee, 2014).

Polyuria PRESENT If blood glucose levels become

too high, the body will try to
remedy the situation by
removing glucose from the
blood through the kidneys.
When this happens, the
kidneys will also filter out
more water and you will need
to urinate more than usual as a
result (Diabetes UK, 2019).

Polydipsia PRESENT When the sugar level in the

bloodstream becomes
excessively concentrated, the
kidney is unable to pull out the
glucose from water. In typical
cases, most of the glucose and
water is taken out of the urine
and sent back into the body.
As the body is no longer able
to reuptake the glucose, the
osmotic pressure builds up.
 The osmotic pressure is what
builds between liquids with
solutes of high concentration
and low concentration. Over
time, this pressure gets so high
that the body is not able to
absorb the water back to the
bloodstream and is thrown out
with urine (Tuli, 2019).

Polyphagia PRESENT High blood sugar levels

directly increase your craving
for food, and in particular,
sugar, because your body
relies on that second-by-
second delivery of glucose in
order to function. When there
isn’t enough insulin present to
actually make use of and
transport that glucose to your
brain and other cells
throughout the body, your
brain cues its signal for hunger
(Vieira, 2019).

Uremic Frost ABSENT Uremic frost is seen in end-

stage renal failure and is an
indication for dialysis. It forms
when sweat containing high
levels of urea evaporates and
the urea crystallizes on the
skin. This finding was
common prior to the
widespread and long-term use
of dialysis (Clinical Advisor,
n.d.).

Blurred PRESENT Insulin is a hormone that

Vision allows the body to break down
sugars that our cells use for
energy. Increased blood sugar
(or blood glucose) can cause
the lenses of your eyes to swell
with fluid, causing distorted
vision or blurriness. If not
 managed, sugar progress
retinopathy ( UCLA Health,
2017). The normally clear lens
sits directly behind the pupil
and helps you focus on
objects. Since light has to pass
through the lens before it can
be focused on the retina, the
result of this swelling is blurry
vision (Debrowski, 2021).

Bubbly Urine PRESENT If the blood glucose levels are

Output too high, the kidneys will have
trouble filtering the blood
properly. This can allow
glucose and protein molecules
from the blood to end up in the
urine, which can cause
foaming (UPMC Health Beat,
2021).

Oliguria PRESENT It is often the earliest sign of

impaired renal function. It is
defined as urine output less
that 400 ml in 24 hours for
adults. (Devarajan, 2017)

Dark Urine PRESENT When loss of kidney function

Output is mild or moderately severe,
the kidneys cannot absorb
water from the urine to reduce
the volume of urine and
concentrate it (Malkina, 2021).

Fruity Urine PRESENT One warning sign of diabetes

Odor or high blood sugar is urine
that smells sweet or fruity. The
sweetness comes from sugar in
the urine and is a sign your
body is trying to get rid of
extra sugar in your blood
(Begum, 2021).
Dry and Itchy PRESENT If levels of glucose in the
Skin blood stay high for a long
time, it can lead to a serious
condition called diabetic
 neuropathy, which means there
is damage to the nerves. This
might be because the high
levels of sugar affects the
capillaries that feed nerves
with oxygen and blood, but
whatever the exact
mechanism, neuropathy can
affect sweat glands and lead to
dry, cracked skin, especially
on the feet (Balmonds UK,
2020).

Poor Wound PRESENT Neuropathy is both a major

Healing cause of injury in individuals
with diabetes, and also a
reason for complications in
diabetes wound healing. When
high blood sugar destroys
nerves, they do not regenerate;
thus many patients with
diabetes are increasingly less
sensitive to pain in their limbs.
With this loss of sensation,
patients don't feel developing
blisters, infections, or existing
wound changes. That means
that wound healing is
complicated not only by the
fact that patients don't feel
wounds as they occur, but they
also have no pain to alert them
that a wound is getting worse
or infected (Wound Source,
2017).

Flank Pain PRESENT Pain in the back can be a

kidney disease if there is
infection or blockage of the
kidneys (National Kidney
Foundation, 2016).

Nasal PRESENT Nasal congestion is due to the

Congestion inflammation of the linings of
the nasal cavity. Swollen nasal
passages constrict air flow,
 making it harder to breathe
through the nose. The
inflammation also makes it
harder to get mucus out of the
patient’s nose, It causes
patients to feel stuffed up
(Vicks, 2022).
Productive PRESENT Blood backs up into the
Cough pulmonary veins back to the
lungs. The buildup eventually
leads to fluid leakage into the
lungs. With the presence of
fluid in the lungs, coughing is
initiated to let the fluid out of
the lungs. The cough produces
a yellowish, thick, mucus
(American Heart Association,
2017).

Crackles PRESENT During inhalation, the air

moves through the alveoli
containing fluid. This
movement produces crepitant
sounds. When the fluid moves
into the larger airways, the
sound becomes louder and
coarser (Hinkle & Cheever,
2018).

Wheezing PRESENT Wheezes are continuous

musical sounds made
predominantly on expiration
and are a sign of airway
obstruction. Widespread
bronchiolar narrowing, as most
commonly occurs with the
inflammation of virus-
associated lower respiratory
tract infection, produces
heterophonies, high-pitched,
sibilant wheezes of variable
pitch and presence in different
lung fields (Park, 2005)
Chills and PRESENT Fever is the rise of body
Fever temperature caused by an
infection. A part in the brain
called the hypothalamus
responds to different factors,
such as infectious organisms
and injury, by releasing fever-
producing chemicals that
change body temperature.
These chemicals cause blood
vessels to narrow and pull heat
into the innermost part of the
bod resulting to increased
temperature (Rush University
Medical Center, n.d.).