Nursing Guide to Walking Pneumonia: Nursing Diagnosis, Interventions, & Care Plans

Walking pneumonia, also known as atypical pneumonia, is a mild form of pneumonia that doesn’t typically require bed rest or hospitalization. Unlike more severe forms of pneumonia, people with walking pneumonia can often continue with their daily activities, hence the name "walking" pneumonia. It’s most frequently caused by Mycoplasma pneumoniae, a small bacterium that spreads easily through respiratory droplets. Other atypical pathogens like Chlamydia pneumoniae and Legionella pneumophila can also cause similar symptoms. 

Walking pneumonia affects people of all ages, but it’s especially common in school-age children, adolescents, and young adults. Symptoms include a persistent cough, mild fever, headache, and fatigue, which develop gradually over a few days to weeks. Though symptoms are typically less severe than in other types of pneumonia, early recognition and appropriate management help in preventing complications. 

Etiology and epidemiology 

Walking pneumonia is often caused by Mycoplasma pneumoniae, a pathogen without a cell wall, making it resistant to penicillin and similar antibiotics. Other causes include: 

• Chlamydia pneumoniae: This is another common cause of atypical pneumonia, especially in young adults and older adults.
• Legionella pneumophila: This causes Legionnaires' disease, a more severe form of atypical pneumonia, often linked to contaminated water systems. 

Walking pneumonia is most common in: 

• Children and young adults: This can be seen particularly in school settings or group housing (e.g., dormitories).
• Crowded environments: Walking pneumonia spreads easily in places where people are in close contact, such as schools, workplaces, and military barracks. 

While walking pneumonia can occur year-round, it is more prevalent in late summer and early fall. 

ICD-10 code 

• ICD-10 code for walking pneumonia: J15.7 (Pneumonia due to Mycoplasma pneumoniae) 

Source: ICD-10 Data 

Diagnosis 

Walking pneumonia is often diagnosed based on clinical presentation and patient history, as symptoms can be non-specific and develop gradually. Laboratory testing and imaging are typically used to confirm the diagnosis. 

Common walking pneumonia symptoms 

• Persistent, dry or minimally productive cough
• Low-grade fever
• Fatigue
• Headache
• Sore throat
• Mild chest pain or discomfort
• Wheezing or shortness of breath (in some cases) 

Diagnostic tests 

• Chest X-ray: While physical examination may reveal little abnormality, a chest X-ray can show diffuse infiltrates or patchy consolidation, which is characteristic of atypical pneumonia.
• Blood tests: Mild leukocytosis or normal white blood cell count. Serologic testing for specific antibodies to Mycoplasma pneumoniae, especially during outbreaks.
• Sputum culture: This is rarely useful in walking pneumonia since Mycoplasma pneumoniae does not grow well in standard culture mediums.
• Polymerase chain reaction (PCR): Rapid and sensitive test to make the diagnosis of Mycoplasma (Consider swabbing throat and nasopharynx)
• Cold agglutinin test: This may be positive in cases of Mycoplasma pneumoniae, but this test is not routinely used due to low sensitivity. 

Differential diagnosis includes viral upper respiratory tract infections, bronchitis, and other causes of atypical pneumonia like Chlamydia pneumoniae and viral pneumonias. 

Management 

Treatment of walking pneumonia focuses on managing symptoms and eradicating bacterial pathogens. In most cases, patients can be treated on an outpatient basis with oral antibiotics and supportive care. 

Walking pneumonia treatment options 

Antibiotics 

• Macrolides (e.g., azithromycin, clarithromycin): This is a first-line treatment for walking pneumonia caused by Mycoplasma pneumoniae and Chlamydia pneumoniae.
• Tetracyclines (e.g., doxycycline): This is effective in older children and adults but not recommended for children under eight years old due to the risk of dental staining.
• Fluoroquinolones (e.g., levofloxacin): An alternative treatment in adults, particularly when other atypical pathogens like Legionella are suspected. 

Symptomatic treatment 

• Antipyretics/analgesics: Acetaminophen or ibuprofen can help manage fever, headache, and muscle pain.
• Cough suppressants: This aims to relieve persistent coughing, although it’s often not necessary.
• Rest and hydration: Encourage adequate rest and fluid intake, though patients are typically able to continue daily activities. 

Preventive measures 

• Infection control: Emphasize hand hygiene and respiratory etiquette, especially in group settings to prevent the spread of Mycoplasma pneumoniae.
• Avoid close contact: Patients with walking pneumonia should avoid close contact with others until they have been on antibiotics for at least 48 hours. 

Walking Pneumonia nursing care plan 

Nursing considerations 

Nursing care for patients with walking pneumonia focuses on relieving symptoms, preventing the spread of infection, and providing education on medication adherence and recovery. 

Assessment 

• Respiratory status: Assess for coughing, wheezing, and shortness of breath. Monitor lung sounds for crackles or diminished breath sounds.
• Vital signs: Regularly monitor temperature and oxygen saturation levels, especially in patients with comorbidities.
• General condition: Assess for fatigue, headache, and overall comfort. Evaluate fluid intake and output to ensure adequate hydration.
• Pain level: Evaluate chest pain or discomfort related to coughing or breathing. 

Nursing diagnosis/risk for 

• Ineffective airway clearance related to persistent coughing
• Activity intolerance related to fatigue and respiratory symptoms
• Risk for infection transmission related to the contagious nature of Mycoplasma pneumoniae
• Deficient knowledge related to the unfamiliarity with walking pneumonia and its treatment 

Interventions 

• Administer prescribed antibiotics. Ensure the patient understands the importance of completing the entire duration of antibiotics, even if their symptoms get better.
• Promote airway clearance. Encourage deep-breathing exercises and use of a humidifier to ease coughing and congestion.
• Provide education on symptom management. Teach the patient how to manage fever and pain with over-the-counter medications and to get adequate rest and hydration.
• Monitor for complications. While rare, walking pneumonia can lead to more severe conditions like respiratory distress or even respiratory failure in vulnerable individuals, so assess for worsening symptoms. 

Expected outcomes 

• The patient will report reduced coughing and fever after 48 to 72 hours of antibiotic therapy.
• The patient will maintain adequate hydration and energy levels to continue with daily activities.
• The patient will demonstrate an understanding of the treatment plan and the importance of infection control measures.
• The patient will complete the full course of prescribed antibiotics without complications. 

Individual/caregiver education 

Education helps ensure that the patient understands the disease process, treatment regimen, and preventive measures. Consider the following when providing patient education: 

• Antibiotic adherence: Stress the importance of completing the prescribed antibiotics, even if symptoms improve within a few days.
• Symptom monitoring: Teach the patient to monitor for worsening symptoms like increased shortness of breath, chest pain, or persistent high fever, which may require further medical attention.
• Preventing the spread of infection: Educate patients on practicing good hand hygiene, covering their mouth when coughing, and avoiding close contact with others until the infection isn’t contagious.
• Self-care: Encourage adequate rest, hydration, and avoiding overexertion while recovering from the infection. 

References 

1. Centers for Disease Control and Prevention (CDC). (2023). Mycoplasma pneumonia. Retrieved from https://www.cdc.gov/mycoplasma/
2. ICD-10 Data. (2023). J15.7 - Pneumonia due to Mycoplasma pneumoniae. Retrieved from https://www.icd10data.com/ICD10CM/Codes/J00-J99/J10-J18/J15-/J15.7
3. Abdulhadi B, Kiel J. (Updated January 2023). Mycoplasma pneumonia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; January 2024. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK430780/