Dave,
I have to check my notes, so this probably isn't exactly correct, but you have to compensate for your altitude changes. Every 1000' of elevation change you go up, you effectively add 2 pressure groups to your current nitrogen load. This is due to the reduced air pressue.
It's covered in the altitude dive portion of the AOW course, and then further in depth in the Altitude Diver specialty.
Of course, if you don't change altitude to dive, you don't need to worry about it. For example, if you live at sea level, and dive in the ocean, there's no concern. Or if we live in Denver, and dive in Aurora Res, there's no concerns. It's all at the same elevation.
It's when we go up high in the mountains and then hop in the water where the problems become an issue.