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

A. Fever is incorrect because fever is a systemic response to infection and often appears after the local infection in the peritoneal cavity has progressed. Relying on fever alone may delay recognition of peritonitis in peritoneal dialysis (PD) clients. B. Increased heart rate is incorrect because tachycardia is a nonspecific sign of stress, pain, or infection. It usually develops later in the course of peritonitis and is not an early or reliable indicator of the complication. C. Cloudy effluent is correct because the presence of cloudy or turbid dialysate is typically the first sign of peritonitis in clients receiving PD. The cloudiness occurs due to an increased number of white blood cells and possibly bacteria in the dialysate, indicating that an infection has entered the peritoneal cavity. Clients may also notice fibrin strands or sediment in the fluid. Early detection of cloudy effluent allows for prompt initiation of antibiotic therapy, which can prevent serious complications such as sepsis or catheter loss. D. Generalized abdominal pain is incorrect because while abdominal discomfort can occur with peritonitis, it is less specific and may be caused by other factors such as the infusion of dialysate, catheter irritation, or constipation. Cloudy effluent is a more reliable and objective early indicator of peritonitis.