Case Details

Patient Information: A lactating patient is calling you for a telehealth visit. A few days ago she noticed that her breast milk looked red and she is worried about breastfeeding her infant daughter.

Setting: Telehealth consultation

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Individual Telesimulation Tasks

Team Telesimulation Tasks

Learner 1

1. Obtain a focused history relevant to the presenting concerns (eg. medical, surgical, family, social, pregnancy, peripartum, breastfeeding)

2. Obtain a focused medical history of a neonate whose mother has bloody nipple discharge

3. Perform a breast assessment (Note: The standardized patient will be wearing a realistic breast model)

4. Instruct the patient to elicit discharge from both nipples

5. Create a management plan based on what you suspect is going on

6. Communicate that management plan to the lactating patient

Learner 1

  1. Obtain a focused history relevant to the presenting concerns (eg. medical, surgical, family, social, pregnancy, peripartum, breastfeeding)
  2. Obtain a focused medical history of a neonate whose mother has bloody nipple discharge

Learner 2

  1. Perform a breast/chest assessment (Note: The standardized patient will be wearing a realistic breast model)
  2. Instruct the patient to elicit discharge from both nipples

Learner 3

  1. Describe the clinical signs associated with breast malignancy to the patient.
  2. Communicate a follow up plan to the lactating patient
  1. Obtain a comprehensive history of the lactating patient and her infant
  2. Perform a breast/chest examination relevant to the chief complaint
  3. Develop a management plan for a lactating patient with bloody nipple discharge
  4. Communicate a management plan to the lactating patient presenting with bloody nipple discharge

Example Question:

Provide the follow-up plan.

Does a lactation visit need to be scheduled for this patient in the next week?
Does this patient need to be seen by their OBGYN or primary care provider in the next week?
Should the infant be taken to the pediatrician in the next few days?

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