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: Fever is a systemic sign of infection that may occur after peritonitis has progressed. While important to monitor, it is not typically the earliest indication of peritoneal infection in clients performing dialysis. B. Cloudy effluent: Cloudy effluent is often the first sign of peritonitis in peritoneal dialysis clients. It reflects the presence of white blood cells or bacteria in the dialysate and allows early detection and prompt treatment of infection. C. Generalized abdominal pain: Abdominal pain can occur with peritonitis, but it usually develops after the initial inflammatory process begins. Pain is a later manifestation compared with changes in dialysate appearance. D. Increased heart rate: Tachycardia can be a secondary response to infection or systemic inflammation, but it does not serve as an early indicator. Monitoring effluent clarity provides the most immediate evidence of peritoneal infection.