Subjective Data To Obtain From Patient Inquiry
Subjective Data To Obtain From Patientinquiry Of Information Medicatio
Subjective data to obtain from patients during inquiry include detailed information about medication usage, encompassing current or prior use of over-the-counter products, vitamins, and herbal supplements. A thorough obstetric and gynecologic history is essential, including the history of pregnancies, miscarriages, abortions, and deliveries, as well as lactation history. Particular attention should be paid to early menarche, nulliparity, or childbirth after age 30, since these factors extend estrogen exposure and may increase the risk of malignant breast cancer. Additionally, it is important to inquire about any history of radiation exposure involving the breast area or adjacent tissues (Hsu et al., 2020). Changes in skin and hair are also relevant subjective data to gather, reflecting possible underlying conditions or systemic effects.
Further systemic information can be obtained by asking about symptoms such as mood disturbances and temperature intolerance, which might indicate endocrine or metabolic issues. It is vital to assess for hematologic or lymphatic problems, including anemia, easy bruising, fatigue, history of blood transfusions, and any family history of anemia, as these could be relevant to breast health. Screening for malignancies in other body systems, such as colon, ovarian, or endometrial cancers, should be included due to their potential to predispose individuals to breast cancer. Lifestyle factors, including dietary habits and alcohol consumption, merit inquiry because they can influence estrogen metabolism and impact breast cancer risk (Hsu et al., 2020).
Objective Data to Assess
Objectively, clinicians should examine for physical signs such as swelling of the legs or hands, which may indicate lymphatic obstruction secondary to tumor spread within dermal lymphatics. A thorough assessment of the thyroid gland for enlargement, as well as the neck region for palpable masses or lymphadenopathy, is important. Examination of the oral mucous membranes and inspection for any skin lesions or abnormalities can provide additional clues. Palpation of the axillary and supraclavicular regions helps identify lymph node involvement.
Diagnostic Exams to Order
To aid in diagnosis, several imaging and laboratory tests are recommended. Mammography remains the primary screening tool for detecting breast lumps, providing detailed information about the size, location, and characteristics of suspect lesions, facilitating early detection (Abu-Naser & Bastami, 2016). A biopsy—either fine needle aspiration or core tissue biopsy—is essential to confirm whether the lesion is benign or malignant. Ultrasound imaging helps measure the lump’s size, evaluate its relation to surrounding tissues, and guide needle biopsies accurately—especially when assessing axillary involvement. Magnetic Resonance Imaging (MRI) of the breast offers detailed visualization of internal structures, useful in complex cases or prior to surgical planning (Abu-Naser & Bastami, 20116).
Three Differential Diagnoses
- Fibroadenoma
- Breast cysts
- Breast cancer
The Rationale for Differential Diagnosis
Diagnosing the cause of a breast lump involves considering key clinical features. Fibroadenomas generally present as smooth, mobile, non-tender, and rubbery masses, often in younger women, with sizes typically ranging from 1 to 3 cm. They are usually painless and mobile, facilitating differentiation from malignant lesions.
Breast cysts tend to be well-circumscribed, mobile, tender, and fluctuate in size with hormonal changes, often causing pain or discomfort. They usually appear in women of reproductive age and may be associated with cyclical tenderness.
Breast cancer typically presents as a non-tender, hard, irregular, and fixed mass that is poorly delineated from surrounding tissue. Features such as nipple retraction, skin dimpling, ulceration, nipple discharge, and pain—particularly in later stages—are characteristic but not always present initially. The non-mobile nature of malignant tumors and their tendency to invade neighboring tissues help distinguish them from benign conditions (Aksan et al., 2020).
Health Education
Providing reassurance to the patient about their body image is crucial, especially when differences are noted between breasts. It encourages open communication of fears, feelings, and concerns. Patients should be advised to report any complications such as fever, increasing pain, or changes in the lump or skin over the breast. Preparing the patient psychologically for potential diagnoses and outlining the treatment and preventive measures fosters compliance and reduces anxiety. Patient education should also include guidance on regular self-breast examinations, awareness of warning signs, and the importance of routine screening programs.
References
- Abu-Naser, S. S., & Bastami, B. G. (2016). A proposed rule based system for breast cancer diagnosis. Journal of Medical Systems, 40(4), 86.
- Aksan, H., Kundaktepe, B. P., Sayili, U., Velidedeoglu, M., Simsek, G., Koksal, S., ... & Uzun, H. (2020). Circulating miR-155, let-7c, miR-21, and PTEN levels in differential diagnosis and prognosis of idiopathic granulomatous mastitis and breast cancer. BioFactors, 46(4), 392-404.
- Hsu, Y. H., Chen, V. C. H., Hsieh, C. C., Weng, Y. P., Hsu, Y. T., Hsiao, H. P., ... & Gossop, M. (2020). Subjective and objective cognitive functioning among patients with breast cancer: effects of chemotherapy and mood symptoms. Breast Cancer, 27(2), 226-234.