What should the nurse assess first for a client with an open leg fracture in the emergency department?

In the case of a patient presenting with an open leg fracture, one of the primary concerns is the risk of infection due to the exposure of bone and surrounding tissue. Assessing the patient’s immunization status, specifically the last time a tetanus vaccine was administered, is crucial in this context. If the wound is contaminated or if the fracture occurred due to a mechanism that poses a significant risk for tetanus (such as a dirty or rusty object), ensuring the patient is protected against tetanus is a priority.

Administering a tetanus shot may be necessary if it's been more than the recommended time since their last vaccination, typically within the last 10 years for clean and minor wounds, and within 5 years for more severe or contaminated injuries. This assessment helps the medical team act swiftly to prevent tetanus infection, which can be life-threatening.

While other assessments such as checking for the last menstrual period, medication allergies, and previous fractures are important for overall patient care, they do not address the immediate risk of infection and the need for vaccination in the context of an open fracture. Thus, ensuring the patient’s tetanus immunization status is a critical initial step in managing the injury effectively.