A nurse is teaching a client and his partner about performing peritoneal dialysis at home. When discussing peritonitis, which manifestations should the nurse identify as the earliest indication of this complication?

Rationale: A. Generalized abdominal pain: Abdominal pain can occur with peritonitis due to inflammation of the peritoneal membrane and irritation of visceral and parietal structures. However, pain may develop after inflammatory processes are already established. It is not typically the earliest observable sign. B. Cloudy effluent: Cloudy peritoneal dialysate is often the earliest and most sensitive indicator of peritonitis in clients undergoing peritoneal dialysis. The turbidity results from an increased white blood cell count in the effluent, reflecting an inflammatory response within the peritoneal cavity. Clients are specifically taught to inspect drainage for clarity with each exchange. C. Increased heart rate: Tachycardia may occur as part of a systemic inflammatory response once infection progresses. It reflects sympathetic activation due to fever, pain, or developing sepsis. This manifestation generally appears after local signs within the peritoneal cavity are already present. D. Fever: Fever develops as pyrogenic cytokines such as interleukin-1 and tumor necrosis factor act on the hypothalamus to elevate the body’s temperature set point. Although fever is a common sign of infection, it often occurs after localized peritoneal inflammation has begun. In peritoneal dialysis–associated peritonitis, changes in effluent appearance are detected before fever.