A 35-year-old client at 29 weeks’ gestation with a history o…
A 35-year-old client at 29 weeks’ gestation with a history of rheumatic heart disease and moderate mitral stenosis (mitral valve area 1.3 cm², NYHA functional class III) presents to a high-risk obstetric clinic reporting worsening exertional dyspnea, difficulty breathing when lying flat, and intermittent palpitations. On assessment, the nurse notes bibasilar crackles and a low-pitched diastolic murmur. Electrocardiogram reveals atrial fibrillation with rapid ventricular response at 138 beats/min. According to American Heart Association / European Society of Cardiology 2024 guidelines for valvular heart disease in pregnancy (WHO class III), which nursing intervention is the highest priority to reduce the risk of maternal decompensation and adverse fetal outcomes?
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