To summarize the nursing care of a patient who developed severe acute respiratory distress syndrome （ARDS） after liver transplantation due to co-infection with pneumocystis jirovecii and cytomegalovirus. To address multiple challenges including severe pulmonary infection，complex medication management，significant risks associated with extracorporeal membrane oxygenation（ECMO），and a prolonged recovery process，the following targeted interventions were implemented. Those included implementing bundled protective strategies to actively prevent secondary infections，refined medication management to enhance the efficacy of ECMO treatment，multidimensional monitoring and nursing care to sustain the safe operation of ECMO，dynamical assessment of nutritional indicators and a stepwise nutritional support plan，conducting early rehabilitation exercises and implementing phased recovery strategies. Through active treatment and meticulous nursing care，the patient recovered smoothly and was discharged.