Cardiac Problems

On my cardiopulmonary placement I have been exposed to a large range of patients. When doing an analysis we commonly have 10 potential problems. Are they present, what priority do they fit? In analysing the patient's problems, there are a lot of other problems that need to be considered, such as anxiety, drowsiness, nausea/dizziness, medication, sedation, ventillator settings etc. Other things like, surgical procedure (complications of, wound, pain Mx) and PMH also play a big role. For instance I presently have a patient who is on SIMV with a peep of 12 and pressure support of 10. This contrindicates the patient for manual hyperinflation. He is on these settings due to previous poor gas exchange. He is sedated, a ex heavy smoker, hx of hypertension and alcohol abuse. Every time ventillator weaning is attempted sats drop to around 91. I thus was thinking could this patient be a CO2 reatainer and we will never see really good sats when he is left to breathe on his own. He becomes agitated when the weaning occurs but this coincides with coming of the sedative meds. Suctioning rises his BP and has the potential to cause more collapse but he does have aspiration pneumonia. I understand that problems can be contrindications but i think a contrindication can also be problems. I realise that prioritising problems can be a very in depth process.