be taken with an appropriately sized cuff, preferably when the newborn is at rest. Consistent tachycardia should be evaluated for conditions such as anemia, hyperthermia, hypovolemia, and sepsis. Consistent bradycardia could be an indication of congenital heart block or hypoxemia. Pallor and central cyanosis (cyanosis in hands and feet is a common and normal finding) can also indicate cardiovascular issues. Ventilation and Oxygenation Physiology: Upon birth, the newborn's lungs become the center for gas exchange. There are a variety of factors that influence newborn respiratory functions; these factors include chemical, mechanical, thermal, and sensory. Respirations begin when fetal aortic and carotid chemoreceptors are stimulated by the varying concentrations of oxygen and carbon dioxide. During vaginal birth, the newborn's chest is compressed by the birth canal. Upon delivery, negative pressure allows air into the lungs. The first cries of the infant allow for alveoli expansion and absorption of fetal lung fluid. Temperature changes and other sensory stimulation contributes to respiratory function as well. Manifestations: Breathing patterns are often irregular and shallow. The infants respiration rate should be between 30 and 60 breaths per minute with preference for nasal breathing. Ribs expands horizontally. Breath sounds should be clear and equal in both lungs. Abdominal breathing is normal. Acrocyanosis is a normal finding. Assessments/Interventions: Suctioning of nasal and oral secretions promotes fluid clearance. Auscultation of lung sounds to assess for any abnormalities. Pulse oximetry is performed to determine oxygen saturation. Monitor signs of respiratory distress such as: nasal flaring, grunting, central cyanosis. Metabolic Physiology: At birth, the newborn is cut off from the mother's glucose supply and will begin to rely on stored fat for energy. Glycogen stores are maximal at term. Within the first hour of life, blood glucose will typically reach its lowest point and then stabilize within 2 to 4 hours, hence breastfeeding is promoted immediately. In cases where feeding is delayed, the neonate can use lactate, free-fatty acids, and ketone bodies. Manifestations: Normal blood glucose levels range from 40 to 50 mg/dl. Rooting and sucking reflex should be present and the neonate will eat small amounts frequently. All vital signs should be within normal limits coinciding with the neonates presentation of calmness and satiation. Assessments/Interventions: Monitor blood glucose level and encourage breastfeeding or formula feeding as early as possible. Lactation and breastfeeding education should be provided as appropriate. Temperature regulation Physiology: Newborns lack the ability of thermogenesis due to